Implementing Lifestyle Medicine Training and Interventions in a Free Clinic in San Bernardino: A Scalable Model to Address Lifestyle Risks in Underserved Communities

Abstract

Lifestyle medicine (LM) interventions are underutilized in underserved communities. This study describes a LM intervention at a resident-led free clinic in San Bernardino, California. Objectives were to quantify changes in LM screening and counseling as well as patient-reported behavior changes. We conducted a retrospective review of 2013-2015 clinic data, examining visit types, LM screening and counseling rates, and patient-reported behaviors (weekly exercise, daily produce intake, and smoking). Descriptive statistics and chi square tests were used to quantify and compare categories of clinic utilization, including encounters, screening, and counseling between time points. Paired t tests were used to assess clinical measures such as glucose, blood pressure, and BMI, and independent t tests were used to assess patient behaviors sucha as exercise and eating habits. In 2015 vs 2014, screening increased for exercise (80% vs 13%, P < .0001), nutrition (75% vs 6%, P < .001), and smoking (86% vs 24%, P < .0001). Reported smoking decreased (60% vs 44%, P < .01), while exercise days rose insignificantly (3.3 vs 2.5, P > .05). From early to late 2015, LM counseling increased (13% vs 47%, P < .05) alongside higher produce consumption (2.3 vs 3.2 servings/day, P < .05). Integrating LM systems changes with resident and community engagement was feasible and associated with improved LM counseling and patient behaviors in a free clinic setting.