Fresh Food Farmacy: A Randomized Controlled Trial

• ClinicalTrials.gov Identifier: NCT03718832
• Recruitment Status: Active, not recruiting
• First Posted: October 25, 2018
• Last Update Posted: August 2, 2023
• Sponsor: John B Bulger, DO
• Collaborators: Massachusetts Institute of Technology; Cornell University; Stanford University; Geisinger Clinic
• Information provided by (Responsible Party): John B Bulger, DO, Geisinger Clinic

Study Description

Brief Summary:

This trial investigates the value created by the highly innovative Fresh Food Farmacy (FFF) program at Geisinger Health. The program provides food-insecure diabetics with healthy food for their entire household: at least two meals per day, five days a week. The program also provides education on how to prepare the food, and education on healthy living including diabetes self management. The research measures the effects of the FFF program on patient health and wellbeing.

Condition or disease	Intervention/treatment	Phase
Type 2 Diabetes	Other: Fresh Food Farmacy	Not Applicable

Detailed Description:

This is a pragmatic, prospective, randomized controlled trial of Geisinger's Fresh Food Farmacy (FFF) program as the program expands to new sites. Qualifying subjects will be randomized 1:1 to receive either early participation in the FFF program (treatment group) or later participation (control group).

Approximately 500 Geisinger subjects will participate in this study with about half assigned to the treatment group and about half to the control group. The treatment group will begin the program soon after trial recruitment: the "Begin Now" group. The control group will begin the program after 6 months: the "Begin Later" group. Approximately 2000 household members will be included in the data-only portion of the research.

Outcomes will include clinical measures, such as HbA1c, survey responses including self-assessed health measures, and utilization / healthy-behavior measures from EHR and paid claims data. These will be measured for subjects and their household members.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 500 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Health Services Research
• Official Title: Fresh Food Farmacy: A Randomized Controlled Trial
• Actual Study Start Date: April 22, 2019
• Estimated Primary Completion Date: November 30, 2023
• Estimated Study Completion Date: November 30, 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: Treatment Group-Begin Now; Group 1- Will be randomized to the treatment ("Begin Now") group for the Fresh Food Farmacy program. Subjects will be consented to join the FFF study prior to learning their program start date. They will join the FFF program right away when the program opens in their geographic area. Data will be collected during the first 12 months of subject participation and EHR and claims data may be analyzed for an additional 12 month follow-up period (24 months in total).	Other: Fresh Food Farmacy; Patients are prescribed fresh food by a dietician, fill the prescription each week at the FFF clinic, receive training on how to use the food, and training in diabetes self management.
No Intervention: Control Group-Begin Later; Group 2- Will be randomized to the control ("Begin Later") group for the FFF program. These subjects will be consented to join the FFF study prior to learning their program start date. They will join the FFF program approximately 6 months after the program opens in their geographic area. Data will be collected during the first 6 months of subject participation and used as control data for the study. EHR and claims data may be analyzed for an additional 12 month follow-up period (24 months in total from the start of the trial).

Outcome Measures

Primary Outcome Measures :

1. HbA1c [ Time Frame: Measured at 6 months after trial enrollment ]
   HbA1c measures blood sugar control

Secondary Outcome Measures :

1. HbA1c [ Time Frame: Measured at 12 months after trial enrollment for all subjects and at 3 months for those whose measurements are available. ]
   HbA1c measures blood sugar control over the prior three months
2. Fasting glucose [ Time Frame: 6 months and 12 months ]
   Fasting glucose measures blood sugar control over a shorter time horizon
3. Weight [ Time Frame: 6 months and 12 months ]
   Weight in pounds
4. Body Mass Index [ Time Frame: 6 months and 12 months ]
   Body Mass Index in kg/m^2
5. Total Cholesterol [ Time Frame: 6 months and 12 months ]
   Total Cholesterol
6. LDL Cholesterol [ Time Frame: 6 months and 12 months ]
   LDL Cholesterol
7. Blood pressure (systolic and diastolic) [ Time Frame: 6 months and 12 months ]
   Blood pressure
8. Triglycerides [ Time Frame: 6 months and 12 months ]
   Triglycerides
9. Patient survey questions on self-assessed health, wellbeing, attitudes toward healthy behavior, self-efficacy, and patient satisfaction [ Time Frame: 6 months and 12 months ]
   Survey questions for the research study will be examined individually and in groups of questions.
10. Healthcare utilization [ Time Frame: 6 months and 12 months ]
    Heatlhcare utilization, including inpatient, ED and outpatient measures in patients' electronic health record
11. Healthcare utilization [ Time Frame: 3 months, 6 months and 12 months ]
    Heatlhcare utilization, including inpatient, ED and outpatient measures in patients' paid claims
12. Healthy behaviors observed in electronic health record [ Time Frame: 6 months and 12 months ]
    Healthy behaviors observed in electronic health record, including preventive care and appointments kept
13. Healthy behaviors observed in paid claims HEDIS measures [ Time Frame: 6 months and 12 months ]
    HEDIS measures of preventive care

Other Outcome Measures:

1. HbA1c for household members [ Time Frame: 6 months and 12 months ]
   HbA1c available in EHR records
2. Weight for household members [ Time Frame: 6 months and 12 months ]
   Weight in pounds as available in EHR records
3. BMI for household members [ Time Frame: 6 months and 12 months ]
   BMI in kg/m^2 in pounds as available in EHR records
4. Cholesterol for household members [ Time Frame: 6 months and 12 months ]
   Cholesterol as available in EHR records
5. Blood pressure for household members [ Time Frame: 6 months and 12 months ]
   Blood pressure as available in EHR records
6. Triglycerides for household members [ Time Frame: 6 months and 12 months ]
   Triglycerides as available in EHR records
7. Fasting glucose for household members [ Time Frame: 6 months and 12 months ]
   Fasting glucose as available in EHR records
8. Inpatient utilization for household members in EHR Records [ Time Frame: 6 months and 12 months ]
   Inpatient utilization for household members as available in EHR records
9. Outpatient utilization for household members in EHR Records [ Time Frame: 6 months and 12 months ]
   Outpatient utilization for household members as available in EHR records
10. Inpatient utilization for household members in paid claims [ Time Frame: 6 months and 12 months ]
    Inpatient utilization for household members as available in paid claims
11. Outpatient utilization for household members in paid claims [ Time Frame: 6 months and 12 months ]
    Outpatient utilization for household members as available in paid claims
12. Heterogeneity: HbA1c by baseline level of HbA1c [ Time Frame: 6 months and 12 months ]
    Separate results by tercile of baseline HbA1c
13. Heterogeneity: HbA1c by site [ Time Frame: 6 months and 12 months ]
    Heterogeneity analysis by site of the clinic
14. Heterogeneity: HbA1c by causal tree [ Time Frame: 6 months and 12 months ]
    Heterogeneity analysis by causal trees using the baseline characteristics to explore heterogeneity, sample size permitting.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 85 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Type II Diabetes and an HbA1c ≥ 8.0 as determined by the most recent measurement in the Geisinger EMR within the prior 12 months
• Food insecure based on a two-question survey instrument
• Age > 17 & Age <86
• Living within geographic reach of the program (Lewistown, PA and Scranton, PA)

Exclusion Criteria:

• Already enrolled in FFF in Shamokin
• Not English speaking (working on changing this as the program evolves)
• On hospice or palliative care
• Acute or chronic psychosis
• Resides in a facility which provides meals

• Active medical disorder that would preclude participation in the classes, weekly clinic visits, or result in a limited diet, including:

  • Cancer; active treatment
  • Steroid dependent asthma/ COPD/ emphysema
  • Steroid dependent Colitis
  • Chronic Kidney Disease with GFR< 30 mg/mmol
  • Celiac disease
  • Cirrhosis
  • Steroid dependent arthritis

Contacts and Locations

Locations

United States, Pennsylvania

Fresh Food Farmacy

Lewistown, Pennsylvania, United States, 17044

Fresh Food Farmacy

Scranton, Pennsylvania, United States, 18508

Sponsors and Collaborators

John B Bulger, DO

Massachusetts Institute of Technology

Cornell University

Stanford University

Geisinger Clinic

Investigators

• Principal Investigator: John Bulger, MD; Geisinger Clinic
• Principal Investigator: Joseph J Doyle; MIT Sloan School of Management

  Study Documents (Full-Text)

Documents provided by John B Bulger, DO, Geisinger Clinic:

Statistical Analysis Plan  [PDF] April 10, 2019

More Information

• Responsible Party: John B Bulger, DO, Chief Health Officer, GIO, Geisinger Clinic
• ClinicalTrials.gov Identifier: NCT03718832
• Other Study ID Numbers: 2018-0297
• First Posted: October 25, 2018
• Last Update Posted: August 2, 2023
• Last Verified: July 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: Deidentified data at the subject level, pending approval from the IRB and Geisinger.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Analytic Code
• Time Frame: Available pending approval from the IRB and after primary publication.
• Access Criteria: To be determined

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by John B Bulger, DO, Geisinger Clinic:

Diabetes