prescription for health fsep 6 18 09
DESCRIPTION
2009 FSEP ConferenceTRANSCRIPT
Jenna M. Bacolor, MPH, MSW Lily Guzmán, MPH, MSW
Washtenaw County Public Health
Why Prescription for Health? Downtown Ypsilanti Farmers’ Market Clinic process 2008 program results Plans for 2009
Patients
Health Clinics
Farmers’ Market
High food insecurity Low consumption of fruits and vegetables New farmers’ market with lots of energy
and partnerships Already programs for low income customers Clinics giving nutrition advice, but… Sense that clinics may not be connected to
local sources of healthy food
City of Ypsilanti
Supermarket
Grocery
Farmers’ market
Specialty grocery
Pharmacy
Convenience-snack
Convenience-alcohol
City of Ypsilanti
• Started in 2006 in response to community food assessment results
• Management• Programs for low-
income customers• Funding from multiple
sources• Marketing &
community events
Primary: increased community awareness and use of farmers’ market
Increased awareness of and utilization of Food Stamps/EBT at market
Increased consumption of fruits and vegetables
Long term…decreased chronic disease risk
Consulted with staff from four clinics: ◦ St. Joseph Mercy Health System - Neighborhood Health Clinic◦ University of Michigan Health System - Ypsilanti Health
Center◦ The Corner Health Center◦ Hope Clinic
Doctor-patient relationship as starting point Grant funding from Ypsilanti Beyer Memorial
Health Foundation paid for tokens; clinics also contributed cash match
Public health provided orientation
Clinics “prescribed” patients PFH packet:◦ $5 in tokens◦ program brochure◦ recipe card◦ pre-program questionnaire
Posters for waiting rooms
Key Findings
Token use at market tracked weekly Pre-program questionnaire completed by
all participants Post-program telephone survey
completed by ~30% of participants Post-program semi-structured interviews
conducted with lead staff at each clinic
344 patients participated◦ 79% female◦ 50% African American, 45% white, 5% Latino◦ Average age: 40◦ 71% less than $15,000 yearly income◦ 49% currently use Food Stamps◦ 2 fruit and 1.9 vegetable servings consumed
on a typical day◦ 80% had not shopped at farmers’ market
before
41% of tokens prescribed were redeemed, resulting in almost $1,500 additional market sales from PFH tokens
Tokens were redeemed June-October By clinic, redemption ranged from 30% to
49%
36%
10%33%
9%12%
"At the clinic, who recommended this program to you?"
Doctor
Social Worker
Front office
Other
Program material
Asked on post-test: 103 respondents
75% of participants became repeat farmers’ market shoppers in 2008
50% of participants spent additional money at the market◦ 95% bought additional produce
51%41%
2%6%
"Next year, how likely are you to shop at the farmers' market on a regular basis?"
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
Asked on post-test: 103 respondents
Overall, 70% of participants lived in Ypsilanti zip codes
Residency varied by clinic
Where patients lived was associated with token use
Home zip code
All tokens redeemed
No tokens redeemed
Ypsilanti Zips
66% 25%
All other 50% 40%
45
27.5
7.55
2.5 2.5
17.5
05
101520253035404550
Percent
"Why didn't you use the tokens?"
Hard to get to market
Market not at good time/dayPoor selection
Cost
Not worth effort
Hard to carry food
Other
Note: Respondents could choose as many answers as they wanted, thus results total more than 100%.
$355 $462
$2,757
$870
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
EBT Sales
EBT Sales 2006-2009
2006
2007
2008
2009
High percentage of patients eligible for food stamps, but only 49% reported receiving them
44% aware of EBT at market Post-test respondents reported increased
consumption of fruits and vegetables, even if they hadn’t redeemed tokens
It appeared that receiving more than one packet increased token redemption
Materials had mixed impact: posters in waiting room were effective; brochures may not have been
Fit with clinic mission: “one stop shopping,” consider “whole person”
Program complemented medical advice Very satisfied with program, but wanted to
increase redemption
Patients residence in 48197 or 48198
Receiving multiple packets
Prescribing earlier in the market season and ending in September
Displaying promotional flyers in waiting room
Expanded to five clinics! Extra coupon on 3 special days – additional
incentive to use tokens – get redemption up Evaluation Repeating EBT message Michigan Department of Community Health
is our funder
Our dedicated graduate student interns: Carissa Williams, UM School of Social Work
and & School of Public Health Leslie Paulson, UM School of Social Work Sarah Freedman, UM School of Social Work
Jenna M. Bacolor, MPH, MSW◦ 734-544-2969◦ [email protected]
Lily Guzmán, MPH, MSW◦ 734-544-2983◦ [email protected]