Montana Partners on a Food Farmacy Initiative to Support BP & Cholesterol Management in the Community

Submission Date: April 2023

State/Territory Submitted on the Behalf of: Montana

States/Territories Involved: Montana

Funding Source: CDC

CDC Funding:

Yes

Grant Number:

DP18-1817: Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes, Heart Disease, and Stroke

Other Federal Funding:

N/A

Other Funding:

Other

Domain Addressed:

Community-Clinical Linkages, Health Equity, Health Systems Strategies

Public Health Issue:

Montana adults reporting hypertension, or high blood pressure (BP), has remained about 30% since 2011. In 2021, high BP prevalence was highest among adults 65 years or older (2021: 53.7%). Men have a higher hypertension prevalence than women (33.7% vs. 27.4%). A heart-healthy lifestyle, including eating foods rich in potassium, calcium, magnesium, fiber, and protein, and lower in sodium and saturated fat, can help keep BP low and protect against heart disease and stroke.

The ability to eat healthy foods depends on accessibility, availability, and affordability. Thirty of Montana’s 56 counties ── almost 72,000 people ── contain areas considered food deserts. While those living in food deserts face a burden of food insecurity, others in Montana face barriers to eating nutritious foods. In Montana, about 1 in 9 people are struggling with hunger, and an estimated 37,000 children go hungry daily.

Project Objectives:

As part of CDC-RFA-DP18-1817 strategies to develop and evaluate new cardiovascular disease prevention and management approaches, the Montana Department of Public Health and Human Services (MT DPHHS) has funded Food Farmacy initiatives.

Objectives for the Food Farmacy projects are to support blood pressure and cholesterol management by:
• improving access and consumption of whole foods;
• facilitating a better understanding of nutrition, diet, lifestyle choices, and health;
• increasing connections with local resources to reinforce education on key pillars of health; and
• slowing and preventing further chronic disease.

Program Action:

Patients with diagnosed high blood pressure or high cholesterol were screened for food insecurity at participating clinics using screening tools such as federal poverty level and a 2-question Hunger Vital SignTM assessment. Eligible patients were referred to organizations addressing food insecurity, providing access to healthier foods based on the DASH diet, and to a public health nutritionist when available.

Funded programs:
Y1:
• FAST Blackfeet and Southern Peigan Health Center, Browning
Y2:
• Partnership Health Center (a Community Health Center {CHC}) and Missoula Food Bank and Community Center, Missoula
• Community Health Partners (a CHC) and Bar 1 Wellness, Belgrade
• St. Peter’s Health and Helena Food Share, Helena
Y3:
• Logan Health Primary Care, Logan Health Primary Care, and Logan Health Primary Care, Kalispell, and Flathead Food Bank, Kalispell, Land to Hand Montana, Whitefish

Data/Other Information Collected:

Clinics reported the number of adults 18 years and older, the number with hypertension diagnosis, and the number with high cholesterol and dyslipidemia in their population. Also collected was the number of patients referred to Food Farmacy programs, the number accepting the referral, and the number of participants completing pre- and post-blood pressure measurements and lipid measures. The MT DPHHS calculated BP at target for all project participants.

Qualitative data collected included barriers and resolutions to them; facilitators; project evolution; successes; and potential system transformation and program sustainability via regular check-in calls and other reporting.

Impact/Accomplishments:

Overall, improvement in BP control was achieved. Patients with BP at target improved from 23% at baseline to 43% after participation.

Project sites established innovative partnerships to support participants, including collaborating with a culinary college to create meals using foods available through the food pantries and partnering with dietetic interns to produce a cooking video. Food pantries said changes they made to food quality and nutrition during the project benefitted all consumers, not just project participants.

Participating sites were able to pilot the work, resolve issues that arose during the pilots, and use their acquired expertise to seek longer-term grant funding. Several sites have leveraged their award dollars into expanded programmatic content and new roles for dietitians and have extended programs through Gus Schumacher Nutrition Incentive Program (GusNIP) awards.

Challenges/Lessons Learned:

A significant barrier identified during the project was the limited time frame to develop the programs, resolve any problems that arose, and see results. Additionally, coordination of diverse partners posed some challenges. Participating healthcare teams needed to establish workflows to identify and refer patients and develop systems to communicate with their community-based partners with varying levels of technology at their disposal. It was sometimes difficult to keep participants engaged, especially those with transportation, housing, and food storage issues, and this required ongoing adaptation. The availability of Spanish speakers for translation services was an additional challenge identified during the pilots.

Next Steps:

With additional grant funding and through new statewide partnerships, Montana DPHHS plans on expanding the Food Farmacy efforts to additional communities.

Program Areas:

Heart Disease and Stroke, Social Determinants of Health

State Contact Information:

Montana
Crystelle Fogle, MBA, MS, RD
Montana Department of Public Health and Human Services
406-947-2344
CFogle@mt.gov

Board President's Challenge:

No

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