PRODUCE PRESCRIPTION PROGRAM

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: NEW
• Funding Source: OTHER GRANTS
• Reporting Frequency: Annual
• Accession No.: 1020937
• Grant No.: 2019-70030-30408
• Project No.: ALKW-2019-04721
• Proposal No.: 2019-04721
• Program Code: PPR
• Project Start Date: Sep 1, 2019
• Project End Date: Aug 31, 2022
• Grant Year: 2019

Project Director
Tressler, E.

Recipient Organization
YUKON-KUSKOKWIM HEALTH CORPORATION
829 HOSPIN HWY STE 329
BETHEL,AK 99559

Performing Department
(N/A)

Non Technical Summary
The YKHC service area is approximately the size of Oregon state and is not on a road system, making the coordination of services and access to resources challenging. Due in large part to transportation challenges, the logistics involved in getting produce to communities throughout the region in a reliable and affordable fashion prevents many families from purchasing fruits and vegetables.In addition to the high cost of food, this region sees some of the highest poverty levels in the nation. YKHC's service area overlaps with three census areas - Kusilvak, Bethel, and Yukon-Koyukuk. According to the Percent of Households that Receive Food Stamps/SNAP - United States - County by State report from 2017, the Kusilvak Census area had the highest percentage of households receiving SNAP benefits in the nation, excluding Puerto Rico, at 58%. Bethel census area ranked number eleven at 39.2% and the Yukon-Koyukuk ranked thirty third with 33.4%.It is believed that providing financial incentives for purchasing fruits and vegetables would help to mitigate the negative health affects created, in part, by the high cost of living and high poverty rates in this region. In so doing, we anticipate increased overall health in the participants of this program.To evaluate the impact of this prescription produce program on participants' health, YKHC will be collecting surveys as well as A1c values from participants. The surveys will evaluate changes in knowledge and behavior, while the A1c values will measure a change in the actual health condition of the participant. The anticipated outcome is for the surveys to reflect increased knowledge on how to purchase fruits and vegetables on a budget, how to incorporate more fruits and vegetables in meals, and whether or not participants' shopping habits have changed over the course of their participation. For the A1c values, the anticipated outcome is to see a decrease in A1c values for participants, correlated to the number of prescriptions received and educational opportunities that participants engage in.

Animal Health Component

0%

Research Effort Categories

Basic

(N/A)

Applied

(N/A)

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6010	1010	100%

Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
6010 - Individuals;

Field Of Science
1010 - Nutrition and metabolism;

Keywords

produce

presciption

Goals / Objectives
Goals:Increase access to fruits and vegetablesObjectives: (1) Prescribe 500 individuals prescriptions to obtain fruits and vegetables with up to 2 refills, tracked through excel spreadsheet; (2) fill refills for 60% of participants, tracked through excel spreadsheet; (3) authorize renewal prescriptions for 50% of participants that complete follow-up requirements, i.e. A1C testingIncrease the health of individuals in the program.Objectives: (1) Decreased A1C 0.5% from baseline compared to A1C performed at follow-up that is required prior to issuing renewal prescriptions, tracked through EHR and excel spreadsheet; (2) look at the # of vouchers actually used, tracked through invoices provided by vendors and tracked on excel spreadsheet

Project Methods
Method: Patients will be seen for appointments at their local clinic. If it is found that a patient is at risk for developing diabetes, or diagnosed with diabetes, and is covered by Medicaid then they will be eligible for participation in this program. Eligible participants must have their A1c values tested before they receive a referral to the diabetes department for a prescription for produce. The diabetes department will verify eligibility and, when appropriate, provide a prescription for produce in the form of a food voucher worth $45 that can be redeemed with participating vendors. The participant will also be eligible for two prescription refills. To receive a refill, they must call the diabetes office to obtain the new voucher. Participants will be able to get a refill once per month, as tracked by the diabetes department. Once all refills are used, the participant must schedule a follow up visit with their provider to obtain follow up A1c tests and case management. At that follow up appointment they will be eligible for another prescription and two refills.Efforts: Classes and educational opportunities will be provided to participants in an effort to promote change in knowledge and actions. The anticipated result is a change in conditions, mainly, lower A1c values compared to baseline A1cs.Evaluation: Results of this program will be analyzed by looking at the number of prescription vouchers utilized and the subsequent A1c values compared to baseline data. Additionally, surveys will be collected evaluating changes in actions regarding what items participants are purchasing at the store and how frequently. Success will be measured with majority of participants seeing a 0.5% decrease in their A1c values.

Progress 09/01/20 to 08/31/21

Outputs
Target Audience:The target audience reached by our efforts during this reporting period are individuals who are diagnosed with diabetes or prediabetes, who are covered by Medicaid, and who live in one of 8 participating communities in our service area. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?This project has worked closely with participating stores to get ready for accepting vouchers. This includes training store staff on what is eligible to be purchased with the produce vouchers, how to track the vouchers, when and how to submit to our department for reimbursement, and what to do if someone spends more or less than the amount of the voucher. Additionally, Diabetes Prevention and Control staff have been trained in how to enroll patients to participate in the program, what the eligibility requirements are, and how to appropriately track data. New/additional diabetes staff have been on the program procedures and how to enroll clients. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we expect to continue distributing vouchers to active participants and collect data from them. Additionally, we will continue to recruit additional, eligible patients to participate in the program in hopes of gaining a large cohort of participants. A Registered Dietitian/Nutritionist has been added to the greater Diabetes Program that will offer education in participating communities/stores.

Impacts
What was accomplished under these goals? Our goals have changed to reflect changes in the way our program is functioning, as approved in a budget modification request submitted to NIFA. The revised goals are listed below. Increasing access to fruits and vegetables: (1) Enroll 150 individuals in the prescription produce program, as tracked through an excel spreadsheet; (2) ensure that 50% of participants remain active in the program, receiving vouchers and completing any required follow up measures (ie. Surveys and lab draws) Our program current has 69 individual participants enrolled in the program. Of those participants enrolled, 93% have remained active in the program. Increasing the health of individuals in the program: (1) Decreased A1c 0.5% from baseline compared with A1c performed at follow-up that is required prior to issuing renewal prescriptions, as tracked through EHR and excel spreadsheet; (2) evaluate the # of vouchers actually used, as tracked through invoices provided by vendors and tracked on excels spreadsheet Our program has ensured that individuals participating in our PPR program are getting their A1cs drawn when appropriate. However, we have not analyzed this data for trends at this time. The plan for the program is to wait until completion before analyzing trends in health outcomes. At this point in time, we are showing a 39% redemption rate of vouchers by participants. We anticipate that this number is lower than the actual rate of redemption because several local stores have been struggling to submit receipts for reimbursement, which is our primary form of tracking redemption.

Publications

Progress 09/01/19 to 08/31/20

Outputs
Target Audience:The target audience reached by our efforts during this reporting period are individuals who are diagnosed with diabetes or prediabetes, who are covered by Medicaid, and who live in one of 8 participating communities in our service area. Changes/Problems:Several changes have been made to the protocol for prescription produce in order to meet the requirements set forth by the Alaska Area IRB and YKHC Human Studies Committtees that are overseeing the research component that has been added to our Prescription Produce Program. The most notable change is that participants are no longer limited to 2 refills, but are able to participate until either the funding for vouchers runs out or the grant period ends. We would be happy to submit the revised protocol, as approved by the Alaska Area IRB and YKHC Human Studies Committee. What opportunities for training and professional development has the project provided?This project has worked closely with participating stores to get ready for accepting vouchers. This includes training store staff on what is eligible to be purchased with the produce vouchers, how to track the vouchers, when and how to submit to our department for reimbursement, and what to do if someone spends more or less than the amount of the voucher. Additionally, Diabetes Prevention and Control staff have been trained in how to enroll patients to participate in the program, what the eligibility requirements are, and how to appropriately track data. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we expect to continue distributing vouchers to active participants and collect data from them. Additionally, we will continue to recruit additional, eligible patients to participate in the program in hopes of gaining a large cohort of participants.

Impacts
What was accomplished under these goals? 1. During this time period our program began registering patients to participate in this program. Due to COVID, it has been challenging to enroll participants as they live in remote locations and often do not have access to internet to send in their forms. Due to this, people rely on being able to go to their local clinics to fill out of the consent forms and submit them, but the clinics are trying to keep people from going to the clinic in person due to COVID. Additionally, the primary airline that delivers mail to our region went bankrupt due to COVID and this has created significant delays in the transportation of mail, making it challenging to mail consent forms to patients and have those forms returned. As such, our enrollment numbers are still low, but consistently growing over time. Additionally, it was decided that we would create a research project to go along with the prescription produce program. This led to delays in implementation of the program, as well as some modifications to our goals. At this point in time, participants are not limited to 2 refills. Instead, they can participate until we either run out of funding oruntil the end of the grant. 2. At this point in time we have not had any follow up labs ordered to determine if there were significant changes to participants A1c levels. All patients are currently working through their first set of vouchers. We anticipate having follow up data available in the next reporting period.

Publications