Ohio Health Center Tests Healthy Food Prescriptions

Community Health and Wellness Partners (CHWP) in Logan County, Ohio, has a new tool to help patients control their diabetes — the Wholesome Rx program, which supplies vouchers redeemable for fresh produce at local farmers’ markets and grocery stores.

Clinical Pharmacist Jason Martinez said the federally qualified health center launched the program this year with funding from a state health department grant.

The only enrollment criterion is a diagnosis of diabetes or prediabetes. Martinez said primary care providers started prescribing the program to eligible patients in February, and recruitment continued until all 130 openings were filled.

CHWP won’t know the program’s effects on patient outcomes until a data analysis is completed. But initial reports are promising.

“We’ve got multiple patients now that have double-digit weight loss,” Martinez said.

There’s also anecdotal evidence that the program is helping participants improve their glycosylated hemoglobin (HbA1_c) levels.

“One of my patients ... went from an A1_c of 11.4 to 7.1 in 3 months,” Martinez said. “It was amazing.”

Another participant’s HbA1_c level had long been stuck at 10–10.5 percent despite multiple approaches to address the problem. After attending group educational sessions and redeeming produce vouchers, the patient told Martinez that things had “clicked” for him.

“His A1_c now is at 7,” Martinez said. “And he kind of stood up in front of the whole class and said ‘Hey, listen to these guys. Because if I would have listened two years ago, I would have been that much further ahead.’”

To administer the program, CHWP works with Wholesome Wave, a nonprofit organization whose mission is to help underserved populations make healthy food choices. The nonprofit has worked with healthcare providers since 2010 to help them offer prescriptions for fruits and vegetables.

Wholesome Wave reported that it spent about $4.5 million to support healthy eating programs in 2017 and contributed, through direct funding and partnerships, to more than $12 million in healthy food purchases by low-income shoppers.

According to the organization, food prescription programs typically run 4–5 months and provide vouchers for each member of the household, redeemable at local stores and farmers’ markets.

Martinez said CHWP’s Wholesome Rx program, which was originally set to end in August but received an additional three months of funding, provides $30 per month for each person in the household.

For a family of four, $30 apiece represents about 20 percent of the local household “survival” food budget, according to Logan County’s 2018 community health risk and needs assessment.

CHWP operates three clinics in the county, which is a rural farming and manufacturing community of about 45,000 residents located in west-central Ohio. Martinez said the clinics are the county’s largest provider of primary care services.

The county estimated in 2018 that about 18 percent of area residents had been diagnosed with diabetes.

Martinez said the Wholesome Rx program provides a venue for the five-year-old health center to offer its first-ever group education classes, which is where participants receive their monthly vouchers.

He said the first set of classes was taught by the health center’s dietitian and showed how to create a healthy plate containing the recommended proportion of fruits and vegetables.

Martinez taught the second set of classes, which focused on incorporating exercise into daily activities to improve insulin resistance and overall health. He said the session also included a “chair yoga” demonstration from a local yoga instructor.

The next set of classes, he said, will focus on behavioral health and how the emotional response to diabetes can affect blood glucose levels. The final classes will address access to fresh produce during the winter months.

The program has also been a vehicle for the health center to improve the screening of patients for food insecurity and other social determinants of health. Martinez said CHWP uses the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences —the PRAPARE tool — to collect data on race, ethnicity, education, income, housing, transportation, social support, stress, and other factors that affect patients’ overall well-being.

The program also collects physical data, including patients’ height, weight, and blood glucose values and receives voucher-redemption data from Wholesome Wave. Martinez said CHWC hopes to show a correlation between voucher use and health improvements.

He said the health center is investigating other funding sources for when the grant period ends.

Meanwhile, Martinez said, his family has using the program’s healthy eating tools — minus the vouchers — to improve their own health.

“I have young children, and now they’re eating many more fruits than they used to. I’ve lost weight, and my wife says she’s lost weight too,” he said.

[This news story appears in the October 1, 2019, issue of AJHP.]