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.

Combined Diet and Exercise Intervention in the Workplace

This study assessed the effectiveness of a 12-week pilot employee wellness program in reducing risk factors for coronary heart disease. Fifty university employees with at least one cardiovascular disease risk factor participated in the program. Interventions focused on diet, exercise, and monthly workshops. Pre- and post-intervention measurements included weight, body composition, blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and blood sugar. Twenty-five employees had post-intervention measurements. A survey was administered to assess adherence. The correlation between adherence and improvement in cardiovascular disease risk factors was also tested. Significant differences were observed between pre- and post-intervention measurements of total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and weight. A significant correlation existed between self-reported level of participation in the diet aspect of the program and improvement in LDL levels. This multi-component, 12-week pilot employee wellness program was effective in reducing cardiovascular disease risk.

The feasibility of meeting the WHO guidelines for sodium and potassium: a cross-national comparison study

OBJECTIVE

To determine joint compliance with the WHO sodium-potassium goals in four different countries, using data from nationally representative dietary surveys.

SETTING

Compared to national and international recommendations and guidelines, the world's population consumes too much sodium and inadequate amounts of potassium. The WHO recommends consuming less than 2000 mg sodium (86 mmol) and at least 3510 mg potassium (90 mmol) per person per day.

PARTICIPANTS

Dietary surveillance data were obtained from the National Health and Nutrition Examination Survey (NHANES 2007-2010) for the USA; the Encuesta Nacional de Salud y Nutrición 2012 for Mexico; the Individual and National Study on Food Consumption (INCA2) for France; and the National Diet and Nutrition Survey (NDNS) for the UK.

PRIMARY OUTCOME MEASURES

We estimated the proportion of adults meeting the joint WHO sodium-potassium goals in the USA, the UK, France and Mexico.

RESULTS

The upper bounds of joint compliance with the WHO sodium-potassium goals were estimated at 0.3% in the USA, 0.15% in Mexico, 0.5% in France and 0.1% in the UK.

CONCLUSIONS

Given prevailing food consumption patterns and the current food supply, implementing WHO guidelines will be an enormous challenge for global public health.

The effects of coronary artery calcium screening on behavioral modification, risk perception, and medication adherence among asymptomatic adults: a systematic review

OBJECTIVE

To perform systematic review of the effects of screening for coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), on behavioral or lifestyle modification, risk perception, and medication adherence.

METHODS

We searched through CINAHL, PsychInfo, Web of Science, Cochrane Central Register of Control Trials, and PubMed (Medline) for studies on the effects of CAC screening in asymptomatic individuals across three major domains: behavioral modification, risk perception for CAD, and medication adherence. We extracted data from the retrieved studies, assessed and synthesized the information.

RESULTS

Of the 15 retrieved studies, three were randomized control trials and 12 were observational studies. CAC score was ascertained either as total score, quartiles, or standardized Agatston's ordinal scale. While all the 15 studies involved issues related to behavioral and medication adherence, four involved risk perception of CAD. Although no standardized approach was used in these studies, CAC screening enhanced medication adherence in 13 of the 15 studies, while the others were mixed.

CONCLUSION

CAC screening improved medication adherence and could likely motivated individuals for beneficial behavioral or lifestyle changes to improve CAD. The mixed results suggest the need for further research because screening for subclinical atherosclerosis has significant implications for early detection and prevention of future cardiovascular events by aggressive risk factors modification.

Barriers to physical activity in people with type 2 diabetes enrolled in a worksite diabetes disease management program

PURPOSE

The purpose of this study was to explore the level of physical activity, barriers to physical activity, and strategies used to meet physical activity goals in people with type 2 diabetes (T2DM).

METHODS

A descriptive, cross-sectional design was used in a sample of 75 adults with T2DM enrolled in a worksite diabetes disease management program (WDDMP). Participants self-reported the length of time they engaged in moderate-intensity physical activity, the frequency of general and specific physical activity, and barriers to participating in physical activity.

RESULTS

Participants who chose to work on physical activity as part of their diabetes self-management had a higher stage of change for physical activity and participated in more general and specific physical activity than did those participants who did not choose to work on physical activity. Participants who were active reported fewer barriers to physical activity and chose to work on more self-care areas to control their diabetes than did those participants who were inactive.

CONCLUSIONS

Participants who chose to work on physical activity participated in more general and specific physical activity and had a higher stage of change for physical activity. Stage of change affects physical activity. While results provide support for the stages of change construct of the transtheoretical model of change, the results do not support that the WDDMP assisted participants in achieving their physical activity goals.

A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback

BACKGROUND

Many health behaviors and physiologic indicators can be used to estimate one's likelihood of illness or premature death. Methods have been developed to assess this risk, most notably the use of a health-risk assessment or biometric screening tool. This report provides recommendations on the effectiveness of interventions that use an Assessment of Health Risks with Feedback (AHRF) when used alone or as part of a broader worksite health promotion program to improve the health of employees.

EVIDENCE ACQUISITION

The Guide to Community Preventive Services' methods for systematic reviews were used to evaluate the effectiveness of AHRF when used alone and when used in combination with other intervention components. Effectiveness was assessed on the basis of changes in health behaviors and physiologic estimates, but was also informed by changes in risk estimates, healthcare service use, and worker productivity.

EVIDENCE SYNTHESIS

The review team identified strong evidence of effectiveness of AHRF when used with health education with or without other intervention components for five outcomes. There is sufficient evidence of effectiveness for four additional outcomes assessed. There is insufficient evidence to determine effectiveness for others such as changes in body composition and fruit and vegetable intake. The team also found insufficient evidence to determine the effectiveness of AHRF when implemented alone.

CONCLUSIONS

The results of these reviews indicate that AHRF is useful as a gateway intervention to a broader worksite health promotion program that includes health education lasting > or =1 hour or repeating multiple times during 1 year, and that may include an array of health promotion activities. These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement.

Workplace-Based Cardiovascular Risk Management by Community Pharmacists: Impact on Blood Pressure, Lipid Levels, and Weight

STUDY OBJECTIVE

To assess the effectiveness of a community pharmacist-delivered cardiovascular case-management program by comparing body mass index (weight), systolic and diastolic blood pressure, and full lipid profile at the beginning of the program with these outcome measures at the end of the program.

DESIGN

Retrospective data analysis using billing data submitted between July 1, 2001, and October 31, 2004, with a pre-post design in which subjects served as their own controls.

SETTING

Manufacturing workplace in rural Iowa.

PARTICIPANTS

Fifty-six workers with risk factors for cardiovascular disease (mean age 40.67 yrs), 37 had diabetes mellitus and 19 did not.

INTERVENTION

During visits to the workers, pharmacists provided education about cardiovascular disease, identification of drug therapy problems, and importance of routine blood pressure, pulse, and weight measurements; they communicated with participants' physicians as needed.

MEASUREMENTS AND MAIN RESULTS

The number of pharmacist visits/participant ranged from 1-13 (mean +/- SD 6.97 +/- 3.05). Outcome measures were weight, systolic and diastolic blood pressures, full lipid profiles (in patients with diabetes), and percentage of patients achieving treatment goal by the end of the 3 years. Statistically significant differences between the first and last visits were achieved for both systolic (124.12 +/- 11.07 and 120.36 +/- 14.39 mm Hg, respectively, p=0.016) and diastolic (80.4 +/- 9.01 and 77.43 +/- 9.14 mm Hg, respectively, p=0.019) blood pressure. The 19 patients without diabetes showed a statistically significant improvement in diastolic blood pressure (p=0.039), but the 37 patients with diabetes did not show a significant difference. A nonsignificant increase was seen in the percentage of patients with diabetes achieving low-density lipoprotein cholesterol (LDL) level goal between the first and last visits (p=0.06).

CONCLUSION

A cardiovascular case-management program delivered in the workplace to middle-aged working adults by community pharmacists improved blood pressure and reduced LDL levels. The program was not effective, however, in weight reduction.

Health Care Cost Implications of Sildenafil Citrate

INTRODUCTION

As prescription drug expenditures increase, third-party payors are increasingly scrutinizing costs and reimbursement guidelines, such as for medications that treat chronic conditions that are not necessarily directly life threatening (i.e., obesity, nicotine addiction, and erectile dysfunction).

AIM

To review the costs and consequences of pharmacy benefit reimbursement policies related to erectile dysfunction therapies, using sildenafil citrate as the case study.

METHODS

Data and references were found through searches of PubMed and Google.

RESULTS AND CONCLUSIONS

To meet the varied health needs of a defined population under reasonable resource constraints requires analysis of cost and of the economic and non-economic consequences of a treatment. Based on analysis of sildenafil data, oral therapy of erectile dysfunction provides substantial cost savings when compared with other treatment options and contributes insignificant overall costs to health plans. Regardless, health plans impose controls to limit reimbursement. Because erectile dysfunction is often a precursor to other conditions, such limitations could compromise detection and management of underlying disease (e.g., depressive, cardiovascular, and urogenital). Reimbursement restrictions may also decrease membership satisfaction and re-enrollment rates.