Patients with Diet-related Disease Prescribed Fresh Food in Detroit ‘Farmacy’ Program
March 24, 2016 | Annamarie Sysling
Dr. Richard Bryce is Senior Staff Physician of Family Medicine at the Community Health and Social Services Center (CHASS) in Detroit. He’s also a “farmacist.”
Dr. Bryce writes prescriptions for fresh fruits and vegetables through the program, Fresh Prescription, which connects low-income patients with chronic diseases related to poor nutrition to farmers markets and nutrition and cooking and counseling services.
We asked Bryce about the program and how it’s helping patients with dietary-related health issues.
Seedstock: Tell us about your background and role in the Fresh Prescription program.
Bryce: I am a family physician at the CHASS Center. The Community Health and Social Services (CHASS) Center has been serving residents of Detroit, with emphasis on the City’s underserved Hispanic and African-American populations, since 1970.
There are many challenges that our patients face that unfortunately take a toll on their health. Many of our patients have limited financial resources that can make it difficult to afford healthy nutritious food. There are many food deserts in Detroit, which, even if one can afford to buy fresh produce, can make it difficult to find fruits and vegetables.
These obstacles have been persistent for quite some time and have poorly influenced food choices of our patient population. For many, they are unaware of how to prepare and implement produce into their daily diets.
This challenge, although immense, is the exact reason I practice medicine. I am passionate about preventing these preventable diseases in my amazing patients.
When did the Fresh Prescription program launch, and how was the need for this program first identified?
The CHASS Mercado grew out of CHASS’ REACH program, a diabetic support program. REACH participants identified fresh fruits and vegetables as a need and, as a result, REACH organized mini-markets in CHASS’ parking lot.
In 2011, CHASS partnered with Detroit Community Markets program to bring a produce stand to its Southwest Center. In 2012, the produce stand expanded to a produce market and today boasts four fruit and vegetable vendors along with a variety of community resources.
Initially titled Health Rx, the fruit and vegetable prescription program began at CHASS in 2013 out of a collaboration between CHASS and the Ecology Center., a local nonprofit with offices in Ann Arbor and Detroit.
What sorts of health issues does the program best work for?
We believe the program works best for patients with uncontrolled chronic disease – high cholesterol, high blood pressure or diabetes. We also allow women that are pregnant and caregivers of children with limited access to fruits and vegetables to participate in the program.
How many people are enrolled in the program currently? Has participation grown?
Participation in the program in Year 1 was 45 individuals, year 2 participation was 127 individuals and in Year 3 we have 152 participants.
How is it financed?
The first two years the program were funded by the GE Foundation. The funding supported two community health workers who did recruitment, orientation and registration in the CHASS Mercado. The funding also supported nutrition education from CHASS’ Registered Dietician. I believe in the long term, with evidence of biometric health benefits, insurance companies will want to get involved.
How are patients approached with this option, and what is the typical response from patients who receive a Fresh Prescription?
We offered around 300 fresh prescriptions. Unfortunately, due to working and other commitments there are some that cannot participate.
How and where can patients get their Fresh Prescriptions filled?
At this time at CHASS, we have a Mercado that takes place every Thursday from June-October. Patients enrolled in the program will get a short orientation, and then will get $10 worth of fruits and vegetable per week up to 4 weeks.
At this time, with the Fresh Rx card they can get their prescription filled at any of our sites.
What have the challenges been in implementing this program?
Unfortunately in our society, we have many preventable diseases. Many of these diseases are caused by poor food choices and lack of physical activity. Interestingly enough, many times we prefer to treat these diseases with pharmaceutical therapies.
Instead of changing the poor habits that contributed to these health problems, often times we prefer to treat them with medicine. These beliefs do not only lie in our patient population. This is a way of thinking that affects many of us in this country including the patients, doctors, insurance companies etc.
This can be difficult to change, however, in three years I have seen this change in some patients before my very own eyes. Once people start eating better, they may understand the health benefits, but more importantly, they feel better!
As we grow, we are always looking for ways to have a more sustainable model to support the program. My belief is the cost of the program now is much cheaper than paying for the consequences’ of these diseases down the road.
What do you hope for the future of this program?
I know there is a lot of interest out there in a model that ties nutrition to medicine and gives access to fresh produce to those in need. We hope to expand and hope to find a more sustainable model to support the program.
We are hoping to find a way to offer more weeks for our patients to participate and also to find ways to get patients fruits and vegetables when the program finishes in October, such as produce boxes.