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The Article in Brief
Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review
Emilia De Marchis , and colleagues
Background Many health care settings are exploring ways to address social determinants of health, including the reduction of patient food insecurity. Health systems have begun experimenting with providing interventions to address food insecurity as a strategy to improve health; however, the impacts of such interventions on food security, patient health and health behaviors, and health care utilization and cost are unclear.
What This Study Found A systematic review of articles covering food insecurity interventions in health care settings from 2000-2018 found that interventions that included either referrals or direct provision of food or vouchers both suffered from poor follow-up, a general lack of comparison groups, and limited statistical power and generalizability. Of the twenty-three studies included in analysis, 74% were rated low or very low quality. In studies of referral-based interventions, there were moderate increases in process outcome--like food program referrals (Standardized Mean Differences: 0.67 95% CI 0.36 to 0.98; 1.42 95% CI 0.76 to 2.08) and resource use (pooled SMD: 0.54 95% CI 0.31 to 0.78). In studies of direct food or voucher interventions, outcomes were mixed, with changes in fruit and vegetable intake averaging to no impact when pooled (-0.03 95% CI -0.66 to 0.61). Studies were limited in their evaluation of health or utilization outcomes, with generally small but positive effects.
Implications
- This review revealed limitations in growing literature on health care-based food insecurity interventions. Low quality and lack of studies examining health or health care outcomes limit inferences about their impacts. More rigorous evaluation of food insecurity interventions is needed that includes health and utilization outcomes to better understand roles for the health care sector in addressing food insecurity.