Pharmacy-based distribution of nutrition and food resources in a safety-net health system

BACKGROUND: Food insecurity has been rapidly rising in Texas, with an average of one in six facing hunger. 

OBJECTIVES: The present study aimed to implement a pragmatic flyer-based approach leveraging existing distribution mechanisms within safety-net health system pharmacies to connect patients with locally available nutrition resources in Dallas County, TX. 

METHODS: This was a cross-sectional study across three different pharmacy distribution settings (mail order, community, clinic) in a safety-net system in Dallas County, TX. Patients were included if they received prescriptions or services within any of the three settings. Nutrition resource flyers were distributed between 9/2024-4/2025 via each pharmacy's unique distribution model. Health related social needs (HRSNs) data were collected and the primary outcome measured was patient interactions (engagement) via quick-response codes (QR Codes) categorized by type of information accessed and pharmacy distribution type. The primary outcome was analyzed using a Poisson regression model with exposure offset. In addition, a basic material cost assessment was conducted. 

RESULTS: A total of 9,916 patients were eligible to receive a nutrition resource flyer and 5,091 flyers were distributed: mail order (2,500 flyers), community pharmacy (2,491 flyers), and clinic (100 flyers). The highest reported overlapping HRSNs included stress, housing instability and transportation barriers. The community setting had significantly higher QR code scan rates compared with the mail order setting (community 7.5/100 flyers vs. mail order 4.9/100 flyers, p<0.0001). The lowest material cost per interaction was in the community pharmacy setting ($3.48/interaction). 

CONCLUSION: A pragmatic approach to addressing food insecurity using existing pharmacy distribution models to deliver a nutrition resource flyer resulted in modest flyer engagement. A slight benefit of distribution from a community setting was observed. Overlapping HRSNs emphasize the need for multi-faceted community resources for patients to access.