Carilion Clinic – Fresh Food Rx

Roanoke, VA
May 2017

Overview
Carilion Clinic’s Fresh Foods Rx program was designed by Healthy Roanoke Valley and its partners, and modeled from the evidence-based model Fruit and Vegetable Prescription Program by Bridgeport, Conn.-based Wholesome Wave. It is a 16-week program (June through October) that targets low-income, uninsured and publicly insured adult patients of Carilion Family Medicine Southeast, Carilion Family Medicine Roanoke-Salem and New Horizons Healthcare who are overweight/obese; diagnosed with diabetes; and live in medically underserved areas in the City of Roanoke (Northwest and Southeast quadrants). Under medical supervision, Fresh Foods Rx provides nutrition and other health education to these adults in a primary care setting and connects them to fresh food using a mobile farmers’ market. Weekly prescriptions valued at $25 each are given to participants as an incentive to purchase fresh fruits and vegetables at the mobile market.

Impact
The 2015 pilot began with 16 individuals, and 11 individuals completed the 16-week program at Carilion Family Medicine Southeast. On average, 11 participants attended the program each week. After the program, improvements occurred in all measured variables, including body mass index, weight, blood pressure and Hemoglobin Alc. Participants self-reported an increase in fruit and vegetable consumption. In 2016, the program was expanded to Carilion Family Medicine Roanoke-Salem and New Horizons Healthcare (in addition to Southeast). A total of 47 patients enrolled in the program, and 31 patients completed the program. Of those patients, 45 percent showed a reduction in body mass index (average of 5 percent reduction in BMI), 32 percent reported an increase in fruit and veggie consumption, 90 percent reported improved health behaviors relating to healthy eating and local foods, 97 percent were satisfied with the overall program, and 70 percent of patients saw a decrease in Hemoglobin Alc (statistically significant reduction of 11 percent overall A1c).

Lessons Learned
Carilion Clinic offers the following advice to other health care organizations who want to achieve similar goals in their communities:

• Conduct the program in partnership with other organizations with similar goals and a stake in the health of the community. Each partner contributed to the success of the program.
• Pair the program with a primary care practice to have the healthy behavior changes be medically prescribed.
• Partner with local farmers. The ability to have a mobile market on site where participants could use their fresh food prescriptions and learn how to shop at a farmers’ market was key to removing barriers to success for participants.
• Offer additional wellness incentives from partners, if possible, such as access to the YMCA. Collaboration made this program successful.
• Participation by large families was less than anticipated. Demographics trended toward mature adult couples and singles, which required modification of meal planning guides and strategies to enhance produce shelf-life.
• Initial navigation of pricing and budget use was unclear to many patients. The program team provided instruction on weighing produce and determining costs.

Future Goals
The program is being offered again in 2017 with the following changes:

• Reduced attendance noted between Weeks 10 and 16; 2017 program abbreviated to 12 weeks.
• Increased emphasis on physical activity was needed; instead of single education session presented in 2016, all of 2017’s sessions open with a brief period of modified aerobic and strength training, encouraging patients to move from a sedentary to a more active lifestyle.
• Initial financial estimate of $25 per week for a family of four; in 2017, voucher cost was reduced to $20 per patient household per week.

Contact: Shirley Holland
Vice President, Planning and Community Development
Telephone: 540-981-9410
Email: sbholland@carilionclinic.org