Team-based pilot program incorporates food vouchers to improve health in patients with diabetes

OBJECTIVE: An evaluation of a team-based pilot program with food vouchers. 

DESIGN: Single-arm prepost mixed-method study. 

SETTING: Two safety-net primary care clinics in San Francisco. 

PARTICIPANTS: Black/African American and/or Hispanic/Latinx patients with uncontrolled diabetes (hemoglobin A1c >8%). 

INTERVENTION(S): Six-month program including pharmacist and nutritionist visits, transportation assistance, and smoking cessation resources, plus $160 per month of grocery and produce vouchers. 

MAIN OUTCOME MEASURE(S): Glycemic control and blood pressure. Secondary outcomes included qualitative insights into program benefits. 

ANALYSIS: Descriptive statistics were used for patient characteristics, voucher use, and program satisfaction. Clinical outcomes used McNemar's tests for paired categorical variables and paired t tests for continuous variables. Interviews were transcribed and analyzed with deductive coding. 

RESULTS: A total of 45 participants redeemed 68.7% of vouchers. Uncontrolled hypertension (≥ 140/90 mmHg) decreased significantly from 45.9% to 21.6% (P = 0.007, n = 41). There was no statistically significant change in mean hemoglobin A1c from baseline to program end (10.1% vs 9.7%; P = 0.17). Mean low-density and body mass index were not significantly different. Major themes from interviews include changes in health behaviors, improved relationships with food, and strengthened engagement with team-based care. 

CONCLUSIONS AND IMPLICATIONS: Combining vouchers and team-based care may be an avenue to improve care for patients with diabetes. Further investigation of this program model through a larger and rigorously designed study is needed for conclusive findings on this approach.