Maintenance of blood pressure treatment and control after discontinuation of work site follow-up

A randomized controlled trial to evaluate outcomes of a workplace self-management intervention and an intensive monitoring intervention

The purpose of this study was to determine and compare outcomes of two voluntary workplace health management methods: an adapted worksite self-management (WSM) approach and an intensive health monitoring (IM) approach. Research participants were randomly assigned to either the WSM group or the IM group by a computer-generated list (n = 180; 92 WSM and 88 IM). Participants completed baseline, 3 and 12-month follow-up surveys. Individuals receiving workplace WSM and IM improved in self-efficacy and nearly all health behaviors and health status variables after the intervention, compared to before the intervention. Individuals in the WSM group improved in depression symptoms at 3 and 12 months (P < 0.0001, P < 0.0001), and individuals in the IM group did not improve at either time period (P < 0.1488, P < 0.0521). Participants in the WSM group reported more improvement in physical activity and energy, health interfering less with personal life and daily activities and fewer depression symptoms at follow up, compared to participants in the IM group. This study provided additional support for worksite-based health promotion programs to promote healthy lifestyles and improve health status, and documented effectiveness of both methods, with superior performance and greater scalability for the WSM program.

Quality of clinical reports on behavioral interventions for hypertension

PURPOSE

The purpose of this study was to provide clinicians with the confidence to employ behavioral interventions for hypertension and to guide researchers in the development and reporting of studies.

METHODS

We systematically reviewed English language articles (1970-1999) describing behavioral interventions for hypertension, evaluating aspects of design, analysis, reporting of results, and factors that were associated with higher quality of these studies.

RESULTS

Of 100 articles, 49 were randomized controlled trials (RCT), 33 were observational studies with control groups, and 18 were observational studies without control groups; mean (SE) quality scores were 69.2 (1.6), 57.6 (5.3), and 60.3 (2.2), respectively. RCTs were more likely than observational studies to attain high scores in descriptions of appropriateness of control group, inclusion and exclusion criteria, study population, and the intervention protocol. In multivariate analysis, date of publication, reported funding source, and intervention type were independently associated with greater quality scores: 7.4 [95% CI: 0.03, 14.7] points greater for articles published 1990-1999 vs 1970-1979, 6.5 [95% CI: 1.4, 11.6] points greater for articles reporting government funding vs those not reporting funding sources, and 8.6 [95% CI: 0.3, 17.1], 12.9 [95% CI: 3.4, 22.4], and 14.2 [4.1, 24.4] points greater for articles examining patient education/support, change in delivery system, and mass health campaigns vs articles examining patient reminders, respectively.

CONCLUSIONS

While quality has improved over time, there is considerable room for improvement. Investigators should pay particular attention to description of study population and allocation of subjects, the use of standardized outcomes reporting, and appropriate statistical analysis.

Worksite cardiovascular wellness programs as a route to substance abuse prevention

This study addresses the question of worksites as an effective route to alcohol abuse prevention. Hypotheses tested include: (1) Cardiovascular disease risk reduction programs provide effective access for alcohol behavior change. (2) Proactive outreach and follow-up have more impact on health behavior change than health education classes. (3) Ongoing follow-up counseling produces the most behavior change. (4) Screening alone produces little change. The study population included 2000 employees, recruited through cardiovascular disease health screening, who were randomly assigned to individual outreach or classes interventions. Changes in the organization of work required more visible outreach, which produced demands for counseling services from many employees who were not in the original group targeted for outreach. After 3 years of intervention, rescreening results strongly supported hypotheses 1 and 2. Spill-over effects from counseling produced plant-wide improvements, so that hypotheses 3 and 4 were not confirmed. This demonstrates that highly visible outreach provides a cost-effective strategy for cardiovascular disease and alcohol prevention.

Evaluation of hypertension screening in the Hutterite population

The purpose of this study was to examine the impact of a hypertension screening program on Hutterites from Alberta, Canada who were found to have a diastolic blood pressure greater than 90 mm Hg. At approximately 16 months postscreening, 200 subjects completed a self-administered questionnaire requesting information about physician follow-up and pharmacologic and nonpharmacologic therapy. Seventy-four percent of the subjects reported that they had their blood pressure measured at least twice since screening. A third of the respondents reported changes in pharmacologic management. Subjects reported weight loss (36%), and salt and alcohol reduction (64% and 48%, respectively) as nonpharmacologic methods for lowering blood pressure. In terms of physician follow-up and pharmacologic and nonpharmacologic modification, the screening program was effective.

Worksite wellness programs: incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization

BACKGROUND

Worksite wellness programs vary considerably in their design. This study tested four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette smoking.

METHODS

Baseline screening was conducted in four manufacturing plants. Site 1 offered screening only, with referral recommendations for those found to have CVD risks. Site 2 also provided health education information and classes. Site 3 added routine follow-up counseling and a menu of intervention types, and Site 4 added social organization within the plant. Random samples of 400 to 500 employees were rescreened at the end of three years.

RESULTS

Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More hypertensives entered treatment and showed greater reductions in blood pressure. Participation in worksite weight loss and smoking cessation programs was significantly increased, and those who participated showed significantly better maintenance of improvements where follow-up was provided.

DISCUSSION

The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk, a variety of health improvement intervention modalities, and ongoing follow-up counseling to help people make decisions and sustain health improvements.

Worksite follow-up and engagement strategies for initiating health risk behavior changes

Information is presented from a multiplant study of interventions to improve cardiovascular health among employees. Risk factors targeted were high blood pressure, obesity, and cigarette smoking. The study utilized on-site wellness counselors who periodically contacted all employees identified through screening as having one or more of the three risks. Use of a structured protocol for client outreach resulted in the large majority of clients being seen in follow-up during the three-year intervention period. Drawing from caseload experience and from various theoretical perspectives, seven engagement strategies were used to help guide at-risk clients toward successful behavior changes to reduce health risks. Results showed that of the three at-risk groups, clients with high blood pressure were most likely to be seen in follow-up, and most likely to begin a risk reduction program. For the overweight and smokers, clients seen three or more times were more likely to begin a weight-loss/smoking cessation program than clients seen less often. Frequency of follow-up showed a positive relationship with risk reduction for all three risks, in samples of employees rescreened at the end of the intervention period, but the relationship was not statistically significant for smoking cessation.