Medical Clinics Expanding Care to Needy

[December 26, 2007]  WASHINGTON (AP) -- An out-of-work David Thomas walked into a Milwaukee food pantry just seeking groceries. Thomas learned he was a stroke waiting to happen and got blood pressure medicine along with his bread.

Food pantries have long aimed to help heal hunger. A new project aims to see how well they can help heal high blood pressure, diabetes and other ailments, too.

It's part of a growing movement to offer medical care for the poor and uninsured in the places where they regularly gather.

"We're taking a window of opportunity approach," says Bill Solberg, director of community services for Columbia St. Mary's Hospital in Milwaukee, which co-founded the food pantry project. "We know we can see these people once a month."

Despite an increasing number of free medical clinics, treatment is hard for the needy to track down. That's especially true for the nation's top health problems - high blood pressure, diabetes and high cholesterol - that require ongoing care even when the person feels no symptoms if they're to avoid heart attacks, strokes, kidney failure and amputations.

Clinics require a special trip, a long wait, perhaps a baby sitter, annoyances for the well-to-do but huge obstacles for someone who must take three buses to reach the doctor or who loses a day of pay for the time off.

Consequently, "they only come when they're out of medicines or have symptoms. It's so frustrating," says Dr. Jim Sanders of the Medical College of Wisconsin.

So specialists increasingly are seeking other ways to address glaring disparities in U.S. health care, by taking care directly to where the people who need it most hang out.

Churches nationwide are offering blood pressure screening days and health fairs. Projects in numerous states are teaching barbers and beauticians how to teach their customers about stroke symptoms or to encourage a mammogram while giving a haircut.

Baltimore health officials are debating expanding the concept, with a proposal to offer blood pressure testing in 100 hair salons and barbershops in neighborhoods with high rates of heart disease.

In Milwaukee, Columbia St. Mary's and the medical college aim to provide scientific evidence that "chronic disease management" - ongoing wellness care - can significantly improve food pantry users' health in nine months.

The targets: High blood pressure, diabetes, high cholesterol, obesity and smoking. The plan: Nurses will screen users of three food pantries for those health conditions when they come in for free groceries. Those with problems can get treated on the spot, with ongoing care as needed.

And because four of those conditions are diet-related, patients also will get nutrition education: Cooking classes in the pantry's kitchen and tips to make the often carbohydrate- and salt-heavy food-bank staples a little healthier. Medical students will be sent shopping with patients, helping with things like label-checking for salt.

Sadly, high-carb and high-fat foods tend to be a lot cheaper than fresh produce, and many of these families feed four for a month on $250, Sanders says.

"Try to talk them into a head of broccoli. It's going to be an eye-opener."

Thomas, 47, learned his blood pressure was a sky-high 194 over 124 while visiting the project's initial food pantry clinic. A nurse told him he was at high risk for a stroke, and he agreed to treatment. Her warnings really sank in days later, when a meatpacking plant checked his health as part of a job interview, and said he'd be hired only after his hypertension was controlled.

Five days after starting pantry-provided pills, Thomas' blood pressure was dropping fast.

"This clinic is going to bring joy to the whole neighborhood," he said.

The program, which aims to treat 2,500 patients over three years, is funded by a $450,000 grant from a charity, but patients are expected to contribute for medications if at all possible. Sanders predicts that for $4 or $5, a month's supply of generic hypertension or cholesterol medicine will be adequate for most. The seriously ill will be sent out for more advanced care, and nurses will enroll patients who qualify into Medicaid or other health programs.

"This is definitely an innovative program," says Dr. Jada Bussey-Jones, a preventive health expert at Emory University.

It's not the first time food banks and medical clinics have teamed up, notes Dr. Georges Benjamin of the American Public Health Association, pointing to a long-standing collaboration in the nation's capitol.

But there's little data showing how well this kind of nurse-led community project works, or that it can be cost-effective, Sanders says.

"The most important principle here is going where the people are," Benjamin says. "There no reason you can't do immunizations there, no reason you can't do nutritional counseling there. ... It makes a lot of sense."

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EDITOR's NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

[Associated Press; By LAURAN NEERGAARD]

Copyright 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.