Questions Remain About How Pharmacists Can Integrate Into Food Pharmacies

In an interview with Pharmacy Times, Anusha McNamara, PharmD, BCACP, and Erin Franey, MPH, discussed the roles for pharmacists in food pharmacies, which are a growing part of the Food as Medicine movement.

Q: How exactly are pharmacists involved in food pharmacies?

Anusha McNamara, PharmD, BCACP: That's a huge question that we're still exploring, because I don't think we have the answer yet. But there's a lot of different models that have emerged for pharmacists’ involvement in food pharmacy. We have a model where patients who come to pharmacy all see a pharmacist in a 30-minute visit, and they do a full comprehensive visit, and it's every single week that the patient comes to the food pharmacy. And so just taking a step back, food pharmacy is usually a weekly event that happens on site at the clinic, the patients are recruited for various things, whatever the clinic feels is necessary, but largely for patients who are Black, African American with uncontrolled hypertension, or who are Latinx with uncontrolled diabetes, because those are the 2 populations in our system that we need to close the equity gap. And so then, in those individual visits, they're on a 12-week cohort and their patients come in every single week.

Then another model is that the pharmacist is doing in communities or like that is the model in the clinic and it's not individual visits. And the model that the clinic chose to go with was a weekly community [food pharmacy]. It’s beautiful, you know, food everywhere that patients come and pick out. And then a pharmacist might do an education session, or they might do blood pressure checks within that community. Patients might come by and say, ‘Oh, I want my blood pressure checked.’ And the pharmacist checks it, pulls up their medical record, and says, ‘Oh, it's high, let me just adjust your medication.’

And then another model might be that the pharmacist isn't physically present but someone in the staff understands what a pharmacist’s role is and identifies people who come to the food pharmacy and says, ‘Oh, your blood pressure's high,’ or ‘You have these medication needs. Let's get you an appointment with a pharmacist.’ And then the pharmacist sees them at a different time.

Erin Franey, MPH: Yes, and Anusha has been thinking about from the perspective of both pharmacists’ time, and also from the outcomes received for patients, kind of what models tend to be the most impactful. And that's something that we're still looking into right now and would be excited to share as we learn more.

Q: Are there any data supporting outcomes with food pharmacy programs and pharmacists’ involvement?

Erin Franey, MPH: Yes, so there's a growing body of evidence to suggest that, again, a whole kind of spectrum of different types of food as medicine programs—so, not just food pharmacy, but let's say a produce prescription, or home delivered meals to a patient, maybe when they've been discharged from the hospital—are very effective in improving health outcomes and also reducing avoidable health care, like emergency room visits or hospitalizations. For our food pharmacy program, we have done some initial non-published research looking into medical records and seen a statistically and clinically significant reduction in blood pressure rates for patients who've been part of the program. We're currently doing a more rigorous study with a researcher at UCSF that's looking at blood pressure for patients within the San Francisco Health Network who've been a part of food pharmacy. But again, just speaking to kind of the more national food as medicine movement, I think there's been just a growing body of evidence that's really supporting that connection between food and health. It’s extremely exciting and looking at things like rates of preterm birth as well as things like hospital admission rates.

Anusha McNamara, PharmD, BCACP: And specifically for the pharmacist models, there's definitely nothing published and not great data yet. I think there's a lot of work to be done to really explore what the outcomes are like with the different models, which one has the best outcomes versus like pharmacists’ time, and like the impact of that. So, I did a quick and dirty analysis and I have some ideas, but definitely not enough to say anything is true yet. But we just matched with our first resident, and I would like in this next year to have that as the research project to figure out what might be the best pharmacy model and our participation in food pharmacy.

Q: Is there anything you’d like to add?

Erin Franey, MPH: I would just add that I think there is such an important role for pharmacists within, at least, our model of food pharmacy that we have been implementing with San Francisco Health Network. Again, I think there's this key hard to measure piece around relationship building and rapport building. And I think folks aren't always necessarily familiar with the role of a clinical pharmacist and how they're part of that care team, and that food pharmacy can be a way to kind of initiate that connection. And I have seen when I spend time at clinic, at the food pharmacy, just the impact of those relationships over time. And folks really, I think, are feeling more empowered over their own health and well-being through the interactions that they're having at the food pharmacy, and the relationships that they're building and kind of the skill building that happens, as well. And I will also say, I just think that these types of food as medicine interventions can be a really amazing tool to advance racial health equity and thinking about patients who have experienced long standing health disparities. Focusing on those patients, I think, is something that I would just really encourage if other folks listening are thinking about how to design a program within their own setting. I’d really encourage you to start there and really work with a partner with patients and think about how to build out a program.

Anusha McNamara, PharmD, BCACP: And one last thing I will say is that I have been a pharmacist in food pharmacy, several years before I became a supervisor, and now I'm overseeing a lot of pharmacists who are in food pharmacy. And it is fun; it's really fun to be part of it and to get to talk to patients about the food that they're getting that day and what they might be doing with it for that week. And it's always a really good mood. Clinic is not always a good mood because, you know, you're like telling patients about their uncontrolled A1c, but even when you have to have those conversations [in the food pharmacy], it still elevates the mood.