As jobless rates rose during the COVID-19 pandemic, millions more Americans experienced food insecurity because they lacked consistent access to food. National health organizations recommend primary care providers screen patients for food insecurity, since not having access to enough food can lead to chronic diseases.

But research from the University of California, Davis, finds that only 7% of primary care providers screened patients for food insecurity. If the appointment was virtual or telehealth, only 3% asked patients about their access to food. The American Journal of Preventive Medicine published the research.

“These rates are surprising and seem relatively small in comparison with what seems like a growing awareness of food insecurity during the pandemic,” said lead author Cassandra Nguyen, an assistant professor of Cooperative Extension in the UC Davis Department of Nutrition.

She said the findings may indicate that health care providers were prioritizing emergency responses to COVID-19. The research showed that once people had access to COVID-19 vaccines, screening for food insecurity increased to 10%.

Barriers to telehealth screenings

Screening for food insecurity at telehealth appointments remained low even after vaccines became available. Nguyen said that may suggest telehealth appointments have unique barriers.

“One of those barriers could be a concern about privacy and whether the patient is alone or feels comfortable discussing a potentially stigmatizing experience such as food insecurity. This may deter a primary care provider from asking about it,” Nguyen said.

Screening might also be more difficult if patients aren’t familiar with the technology needed or if there are technological disruptions during telehealth appointments. Nguyen said more study is needed about potential barriers given the increased popularity of telehealth appointments since the pandemic.

The research examined electronic health records and clinic data from a national network of more than 400 community health centers in 16 states. It examined encounters between March 11, 2020, and Dec. 31, 2021. Screening typically involves a primary care provider asking the patient to answer that either or both of the following two statements is often true or sometimes true:

• Within the past 12 months we worried whether our food would run out before we got money to buy more.
• Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.

Co-authors include Rachel Gold with OCHIN Inc. and Kaiser Permanente Northwest Center for Health Research; Alaa Mohammad, Dedra Buchwald and Clemma Muller with Washington State University; Molly Krancari, Megan Hoopes and Suzanne Morrissey with OCHIN Inc.

The National Center for Advancing Translational Sciences of the National Institutes of Health, and the National Institute of Diabetes and Digestive and Kidney Diseases supported the research.