Food insecurity screening in primary care: Patterns during the COVID-19 pandemic by encounter modality.

INTRODUCTION: Screening for food insecurity in clinical settings is recommended, but implementation varies widely. This study evaluated the prevalence of screening for food insecurity and other social risks in telehealth versus in-person encounters during the COVID-19 pandemic, and changes in screening before versus after widespread COVID vaccine availability.

METHODS: These cross-sectional analyses used electronic health record (EHR) and ancillary clinic data from a national network of 400+ community health centers with a shared EHR. Food insecurity screening was characterized in 2022 in a sample of 275,465 first encounters for routine primary care at any network clinic during March 11, 2020-December 31, 2021. An adjusted multivariate multi-level probit model estimated screening prevalence based on encounter mode (in-person versus telehealth) and time period (initial pandemic versus after vaccine availability), in a random subsample of 11,000 encounters.

RESULTS: Encounter mode was related to food insecurity screening (p<0.0001), with an estimated 9.2% screening rate during in-person encounters, compared to 5.1% at telehealth encounters. There was an interaction between time period and encounter mode (p<0.0001), with higher screening at in-person vs. telehealth encounters after COVID-19 vaccines were available (11.7% v. 4.9%) versus before vaccines were available (7.8% v. 5.2%).

CONCLUSIONS: Food insecurity screening in first primary care encounters is low overall, with lower rates during telehealth visits and the earlier phase of the COVID-19 pandemic. Future research should explore methods for enhancing social risk screening in telehealth encounters.