PCPs less likely to screen for food insecurity during telehealth visits

Key takeaways:

• Overall, food insecurity screening rates were low during the COVID-19 pandemic.
• Screenings were more common during in-person vs. telehealth visits and increased after COVID-19 vaccines became available.

Food insecurity screening rates during primary care visits were low overall throughout the COVID-19 pandemic, particularly during telehealth encounters, indicating a need for greater implementation, according to researchers.

The prevalence of food insecurity has increased over the past couple decades. Previous research has shown that it is associated with negative health effects, including greater health care costs and mental health conditions.

“We were interested in understanding how food insecurity screening patterns changed during the pandemic, particularly as more providers adopted telehealth to provide care,” Cassandra J. Nguyen, PhD, an assistant professor of cooperative extension at the University of California, Davis, and Rachel Gold, PhD, MD, an epidemiologist at Kaiser Permanente, told Healio.

Nguyen, Gold and colleagues performed cross-sectional analyses of shared electronic health record and ancillary clinic data on patient encounters, taken from a national network of more than 400 community health centers. The study included 275,465 routine primary care encounters that were conducted in person and over telehealth from March 11, 2020 to Dec. 31, 2021.

The researchers reported in the American Journal of Preventative Medicine that there was a 9.2% screening rate for in-person encounters (n = 198,015), compared with a 5.1% screening rate for telehealth encounters (n = 77,450).

While the prevalence of screening remained low through the examined time span, screening rates did increase from 6.5% (95% CI, 3.5-9.5) during the first 14 months of the pandemic to 8.3% (95% CI, 5-11.7) after COVID-19 vaccines became available. This finding was driven by an increase in screening during in-person encounters, which rose from 7.8% to 11.7%. Meanwhile, there was no significant difference in screening rates during telehealth encounters (5.2% vs. 4.9%).

The researchers suggested that the lower likelihood of food insecurity screening during telehealth visits was likely influenced by “the known challenges of providing any care via telehealth,” including privacy concerns, technical difficulties and inexperience with digital platforms.

“However, additional barriers unique to screening for social risks may further drive these differences,” they wrote. “It is possible that food insecurity screening is more likely to happen during in-person encounters as a result of greater rapport between patient and provider or because additional observations made during the visit serve as a stimulus to social risk screening.”

Nguyen and Gold said the findings align with their expectations.

“Over time, we’ve seen food insecurity screening occurring at more encounters than prior years,” they said. “However, greater support for implementation of screening recommendations is warranted. Our results highlight this need for support may be greater when it comes to telehealth encounters.”

Gold added that “implementation and acceleration of food insecurity screening is complex and requires leadership support, staff training, and a range of resources for making this practice change.”

For suggestions on how to implement food insecurity screening, Gold said more information can be found here.