P3B144: Clinician Experiences with a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network

Background: In 2021, 1 in 8 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and professional organizations continue to call upon pediatric clinicians to actively screen and intervene in clinical settings. There is a need to explore what makes for an effective FI protocol in the pediatric clinical setting. This research aims to evaluate the feasibility and impact of an FI management protocol implemented in 2017 on clinician practices and attitudes at a large urban pediatric primary care network serving primarily Medicaid-eligible patients in Washington, DC.

Methods: In 2019, a cross sectional analysis was conducted within a convenience sample of 42 clinicians working within a large pediatric health network to examine clinical knowledge, behavior, and attitudes surrounding a FI protocol. Clinicians were asked to complete an 18-item survey containing quantitative and free-response questions. Quantitative responses included 5-point Likert-type scales, which were simplified into two response categories with frequencies reported. We identified common themes from free-response answers, which were used to interpret survey results.

Results: The survey was completed by 35 out of 42 primary care clinicians. All respondents reported universal screening for FI (100%) at routine examinations, 80% of clinicians reported electronically documenting FI in medical records, and 80% of clinicians reported frequently referring families who screened positive for FI to identified community resources, with 23% reporting that resources were meeting families' needs at future screenings. Qualitative analysis of clinician free-responses revealed increased awareness of the prevalence of FI and of patient experiences in food-insecure households, confidence with clinical management of FI, and challenges around limited clinical time and patient access to resources.

Conclusion: After implementation of a comprehensive FI protocol, pediatric clinicians described successful integration into clinical workflows and noted opportunities to improve clinical, community, and patient experiences to optimize FI management. Future FI protocols in the pediatric setting should consider methods of addressing clinician time burden and patient inability to access resources, such as minimizing clinician documentation and putting the resource referral process outside of clinic time, and engaging in direct partnerships with community-based organizations to support patients and families.