5 things you should know about screening patients for food insecurity

Dr. Christina Suh, a pediatrician and Director of Clinical Content at Phreesia, answers five key questions about food insecurity screening.

It’s estimated that 42 million Americans may experience food insecurity in 2021, a public health crisis that has worsened with the COVID-19 pandemic. In this blog post, based on a recent Becker’s Healthcare Podcast interview with Christina Suh, MD, MPH, a pediatrician and Director of Clinical Content at Phreesia, we answer five key questions about screening for this critical social need. Learn why it’s important for your organization to screen every patient for food insecurity and listen to the full podcast here.

1. What is food insecurity?

Food insecurity is a lack of consistent access to enough food to live a healthy and active life. It’s a social determinant of health—one of the conditions of our life that affects our health. It’s not typically a permanent condition—people move in and out of food insecurity as their financial conditions change.

Healthcare providers care about food insecurity because it is closely connected to overall health. It can worsen chronic conditions like type 2 diabetes and high blood pressure and amplify behavioral health issues. Food-insecure children are more likely to be hospitalized or struggle with behavioral health issues and have more problems in school.

2. What impact has COVID-19 had on food access?

The pandemic has exacerbated levels of food insecurity. Prior to the pandemic, food insecurity rates were decreasing nationally in tandem with decreasing rates of unemployment and poverty. But as the pandemic hit, and people lost their jobs, food insecurity skyrocketed. About one in seven people, including one in five children, have experienced food insecurity during the pandemic, and that rate is even higher in racial and ethnic minority communities. 

3. How should healthcare providers screen for food insecurity?

One of the most common and simple tools is the Hunger Vital Sign™, a two-question screening tool developed by Children’s Health Watch. With this tool, a household is considered at risk for food insecurity if either or both of the following statements are “often true” or “sometimes true”:

  1. Within the past 12 months, we worried whether our food would run out before we got money to buy more.
  2. Within the past 12 months, the food we bought just didn’t last, and we didn’t have money to get more.

In addition to the Hunger Vital Sign™, other screening tools that capture food insecurity data include: Health Leads; PRAPARE (Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences); CMS Accountable Health Communities Health-Related Social Needs Screening Tool; and the SWYC™ (Survey of Well-being of Young Children). Asking social-needs questions in a digital format, instead of verbally or on paper, allows patients to respond in the privacy of their own home and feel less stigma.

The reason we screen—rather than expecting patients to bring this up in conversation—is because there is significant stigma associated with being food-insecure and hungry. It’s a very hard topic to talk about, even if you have a trusting, close relationship with your primary care provider. As a provider, you just don’t know if you patient is suffering in this way. You can’t tell by simply looking at them.

4. Should every patient be screened?

Universal screening is a best practice, not only because it ensures that every patient’s needs are assessed, but also because it normalizes the experience of being asked. Verbally screening every patient at every visit can be a challenge for clinicians who are pressed for time in the exam room and have many other tasks to complete. Collecting this information digitally during the intake process allows healthcare organizations to screen reliably, at scale.

5. At what point during the patient journey should food-insecurity screening take place?

Repeat screening over time is important because patients’ socioeconomic conditions may change without your knowledge. By incorporating screening into the digital intake process, you not only ensure that every patient gets asked the same standardized questions, you also generate important information for clinical staff, who now have more time to have an informed conversation with the patient about his or her needs.  

Screening for food insecurity is an important part of getting patients the resources they need to live a healthy life. Learn more about how Phreesia can support your patient screening efforts and help identify patients who are at risk for this and other social determinants of health.