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Impact of Worksite Wellness Intervention on Cardiac Risk Factors and One-Year Health Care Costs
Abstract
Cardiac rehabilitation and exercise training (CRET) provides health risk intervention in cardiac patients over a relatively short time frame. Worksite health programs offer a unique opportunity for health intervention, but these programs remain underused due to concerns over recouping the costs. We evaluated the clinical efficacy and cost-effectiveness of a 6-month worksite health intervention using staff from CRET. Employees (n = 308) and spouses (n = 31) of a single employer were randomized to active intervention (n = 185) consisting of worksite health education, nutritional counseling, smoking cessation counseling, physical activity promotion, selected physician referral, and other health counseling versus usual care (n = 154). Health risk status was assessed at baseline and after the 6-month intervention program, and total medical claim costs were obtained in all participants during the year before and the year after intervention. Significant improvements were demonstrated in quality-of-life scores (+10%, p = 0.001), behavioral symptoms (depression -33%, anxiety -32%, somatization -33%, and hostility -47%, all p values <0.001), body fat (-9%, p = 0.001), high-density lipoprotein cholesterol (+13%, p = 0.0001), diastolic blood pressure (-2%, p = 0.01), health habits (-60%, p = 0.0001), and total health risk (-25%, p = 0.0001). Of employees categorized as high risk at baseline, 57% were converted to low-risk status. Average employee annual claim costs decreased 48% (p = 0.002) for the 12 months after the intervention, whereas control employees' costs remained unchanged (-16%, p = NS), thus creating a sixfold return on investment. In conclusion, worksite health intervention using CRET staff decreased total health risk and markedly decreased medical claim costs within 12 months.
... Although there are not specific criteria defining what constitutes a health promotion or wellness program, they are often used to enhance physical activity (5,31). Some common components of these programs are exercise, wellness, stress management classes or challenges, smoking cessation counseling, and activity tracking (1,2,5,25,31,32). These programs have been implemented in corporate settings to increase health and physical activity and decrease health care costs for employees (31). ...
... Participation in such programs can improve body mass index (BMI), blood pressure, and cholesterol levels (28). Wellness programs have also been shown to decrease medical claim costs within 12 months of implementation (25). The use of pedometers or other types of activity trackers has increased among the general public as well as an objective measure for research purposes (11,13,37). ...
... These seminars covered topics to include nutrition, stress management, fitnessrelated goal setting, and exercise selection for cardiovascular and strength training. Second, previous studies that have reported positive changes have been general population subjects with health and wellness program durations of 6 months up to 8 years, a longer duration than this study (25,28,31). Finally, it is difficult to make direct comparisons between the current data and previous studies because of the differences in variables and outcome measures reported. ...
Hibbert, JE, Klawiter, DP, Schubert, MM, Nessler, JA, and Asakawa, DS. Strength, cardiovascular fitness, and blood lipid measures in law enforcement personnel after a 12-week health promotion program. J Strength Cond Res 36(11): 3105-3112, 2022-Law enforcement personnel often have high rates of cardiovascular disease and injury. Health promotion programs have been found to successfully encourage behavior change among law enforcement personnel, but these programs can often be intensive and expensive. Thus, the purpose of this study was to examine the efficacy of a health promotion program on body composition, metabolic health, muscle strength, and cardiovascular endurance in law enforcement personnel. Active duty officers from a local law enforcement agency were invited to participate in a 12-week health promotion program that included activity tracking and exercise and nutrition education. Eighteen subjects underwent measurements of body composition, V̇ o2 max through treadmill test, knee extensor strength, and blood lipids. An a priori alpha level for significance was set at 0.05, and comparisons were assessed using paired t -tests. Overall, subjects improved blood lipid levels evidenced by movement of mean values toward established healthy ranges. Although 8 subjects improved their V̇ o2 max (range: 1.3-30% change), there was large variability and no statistically significant differences in measures of V̇ o2 max (pre: 38.48 ± 5.86 ml·kg·min -1 ; post: 39.27 ± 5.26 ml·kg·min -1 ), body composition (pre: 26.52 ± 8.02% body fat; post: 26.44 ± 7.45% body fat), and strength normalized to body mass (isometric pre: 1.45 ± 0.45; post: 1.08 ± 0.36). Although no significant changes were noted, promising trends in these data suggest that health promotion programs with a modified focus may lead to positive changes in overall health.
... показало, что ROI достиг 6 долл. на каждый доллар, вложенный в программу коррекции факторов риска ХНИЗ, а среднегодовые затраты на медицинские выплаты сотрудникам снизились на 48 % [24,25]. ...
... Наиболее активное развитие программы укрепления здоровья получили на предприятиях с действующими [24,25]. ...
... Снижение затрат на здравоохранение на 18-26 % [26,27] Profit of 3.27-6 dollars for every dollar of investment [24,25]. Reducing health care costs by 18-26% [26,27] Абсентеизм Absenteeism Снижение расходов на 25-30 % [29]. ...
Cardiovascular diseases are the leading cause of disability, premature mortality and economic loss worldwide. Despite the proven effectiveness of preventive measures in reducing the risks of development and progression of cardiovascular diseases, these programs are the most difficult to implement. 75–90 % of visits to primary care physicians in Western Europe and the United States are associated with physical fatigue and stress disorders, back pain and injuries. Studies have shown that workers with risk factors for chronic noncommunicable diseases are often absent from the workplace, have a higher level of disability and lower labor productivity. A worker with depression costs the employer almost 1,5 times more expensive than people without diseases. Elevated glucose levels, arterial hypertension, smoking and obesity cause an increase in the employer’s medical expenses by 34,8; 31,6; 31 and 27,4 %, respectively. The cost of US employers to pay for medical services, to compensate for the absence or ineffective presence due to illness costs 1,500 per employee.The health of workers is determined by both risk factors specific to the workplace and general population and individual risks..Modern technologies of health management, changing the profile of the health of labor collectives, can improve the image of the employer and increase the profitability of companies. The return on investment in corporate health programs is from 3 to 10 US dollars for each dollar invested. The programs implemented at the enterprises of the Russian Federation made it possible to reduce the duration of diseases with disability by 20–30 %, reduce mortality and the initial exit to disability by 45–60 %. The widespread introduction of the most effective corporate wellbeing programs of workers in the activities of medical organizations and companies of various profiles will ensure the implementation of the national projects “Healthcare” and “Demography”.
... As a result, 23 RCTs reported in 24 articles met criteria for inclusion in the systematic review. For meta-analysis calculations, we used 20 RCTs reported in 21 articles because three RCTs Milani and Lavie, 2009;Siddiqui et al., 2019) of the 23 RCTs included in the systematic review did not report the necessary data after contacting the authors (see Fig. 1). Siddiqui et al., 2019;Brotons et al., 2011;Hofman-Bang, 1999;Jørstad et al., 2016;Lisspers et al., 1999;Azami et al., 2018;Davies et al., 2016;Moore et al., 2011;Ruusunen et al., 2012;Wang et al., 2014;Rosal et al., 2005;Gallagher et al., 2014;Poston et al., 2013;Molyneaux et al., 2018;Bogaerts et al., 2013;Kim et al., 2011), five online (Pfaeffli Duan et al., 2018;Shariful Islam et al., 2019;Mensorio et al., 2019;Duan et al., 2017), one in the workplace (Milani and Lavie, 2009), and one in the home . ...
... For meta-analysis calculations, we used 20 RCTs reported in 21 articles because three RCTs Milani and Lavie, 2009;Siddiqui et al., 2019) of the 23 RCTs included in the systematic review did not report the necessary data after contacting the authors (see Fig. 1). Siddiqui et al., 2019;Brotons et al., 2011;Hofman-Bang, 1999;Jørstad et al., 2016;Lisspers et al., 1999;Azami et al., 2018;Davies et al., 2016;Moore et al., 2011;Ruusunen et al., 2012;Wang et al., 2014;Rosal et al., 2005;Gallagher et al., 2014;Poston et al., 2013;Molyneaux et al., 2018;Bogaerts et al., 2013;Kim et al., 2011), five online (Pfaeffli Duan et al., 2018;Shariful Islam et al., 2019;Mensorio et al., 2019;Duan et al., 2017), one in the workplace (Milani and Lavie, 2009), and one in the home . With respect to delivery, six were administered by nurses Hofman-Bang, 1999;Jørstad et al., 2016;Lisspers et al., 1999;Azami et al., 2018;Bogaerts et al., 2013;Kim et al., 2011), nine by other healthcare professionals Moore et al., 2011;Ruusunen et al., 2012;Wang et al., 2014;Rosal et al., 2005; Treatment duration and follow-up periods ranged from 2 months to 36 months. ...
... The session format varied across studies. Six RCTs used individual and group sessions (Milani and Lavie, 2009;Hofman-Bang, 1999;Lisspers et al., 1999;Moore et al., 2011;Rosal et al., 2005;Gallagher et al., 2014;Bogaerts et al., 2013), and five used individual sessions Brotons et al., 2011;Jørstad et al., 2016;Ruusunen et al., 2012;Surkan et al., 2012). Eighteen RCTs included face-to-face sessions Milani and Lavie, 2009;Siddiqui et al., 2019;Brotons et al., 2011;Pfaeffli Dale et al., 2015;Hofman-Bang, 1999;Jørstad et al., 2016;Lisspers et al., 1999;Azami et al., 2018;Davies et al., 2016;Moore et al., 2011;Ruusunen et al., 2012;Wang et al., 2014;Rosal et al., 2005; Table 1 Characteristics of the studies included in the systematic review. ...
Though many studies have explored the association between single-risk lifestyle interventions and depression, unhealthy lifestyle factors often co-occur, with adults engaging in two or more risk behaviours. To date, little is known about the effectiveness of universal multiple-risk lifestyle interventions to reduce depressive symptoms. We conducted a SR/MA to assess the effectiveness of universal multiple-risk lifestyle interventions (by promoting a healthy diet, physical activity and/or smoking cessation) to reduce depressive symptoms in adults. We searched MEDLINE, Scopus, CENTRAL, PsycINFO, WOS, OpenGrey, the ICTRP and other sources from inception to 16 September 2019. We selected only randomized controlled trials, with no restrictions on language or setting. Our outcome was the reduction of depressive symptoms. We calculated the standardized mean difference using random-effect models. Sensitivity, sub-group and meta-regression analyses were performed. Of the 9386 abstracts reviewed, 311 were selected for full-text review. Of these, 23 RCTs met the inclusion criteria, including 7558 patients from four continents. Twenty RCTs provided valid data for inclusion in the meta-analysis. The pooled SMD was −0.184 (95% CI, −0.311 to −0.057; p = 0.005). We found no publication bias, but heterogeneity was substantial (I² = 72%; 95% CI: 56% to 82%). The effectiveness disappeared when only studies with a low risk of bias were included. The quality of evidence according GRADE was low. Although a small preventive effect was found, the substantial heterogeneity and RCTs with lower risk of bias suggested no effectiveness of universal multiple-risk lifestyle interventions in reducing depressive symptoms in a varied adult population. Further evidence is required.
... In forming a conceptual model, available health practices are extremely important in the discussion of effective wellness programs. There are a number of essential elements for a sound and balanced corporate wellness program (Baicker et al., 2010;Milani and Lavie, 2009). Screening activities, which includes procedures to identify high-risk groups and areas of vulnerability, is probably one of the most important and earliest elements to implement. ...
... According to information provided by the Center for Disease Control (2010), health risk appraisal is a systemic approach to collecting individual information that identifies risk factors, provides individualized feedback, and links the person with at least one intervention to promote health, sustain function, and/or prevent disease. Though the term health risk appraisal may sometimes be used interchangeably with the term health risk assessment, it is important to note "assessment" refers specifically to the instrument used to collect data while "appraisal" is the process of data collection, interpretation, and intervention (Bard, 2011;Milani and Lavie, 2009). Risk profiling of employees is an important part of a wellness program, and targeted interventions yield increased effectiveness and return-on-investment. ...
... In the development of a conceptual model, personal resources and the ability for employees to be knowledgeable of their health choices and being able to afford should options are also critical in the development of an effective wellness program. With employees spending one-third of their day in often sedentary positions, the workplace has potential to significantly impact employee behavior (Baicker et al., 2010;Hart, 2013;Milani and Lavie, 2009). Common techniques include simple offerings of little to no cost gym memberships, encouraging physical activity throughout the workplace culture, and 1528 BIJ 24,6 allowing exercise during company time. ...
Purpose
With the passage of the Affordable Health Care Act in the USA, many companies are investing in corporate wellness programs as a way to reduce healthcare costs and increase productivity of their workforces. Increasing healthcare expenditures and the pandemic of obesity and chronic diseases are driving forces to the development and implementation of workplace wellness programs across the globe. Companies expect to experience a return on their investment through lower healthcare costs and increased productivity. The paper aims to discuss these issues.
Design/methodology/approach
In this study, 109 business professionals were surveyed (primarily almost equally divided between Russian and Americans citizens) to examine their health-promoting and health risk behaviors. Demographics were compared in an effort to identify the key differences in order to pinpoint development opportunities to increase efficiencies among target populations.
Findings
According to the results, nationality was related to certain differences in health-promoting behaviors, participation rates and frequency of wellness programs offered by employers. No differences were found among different age groups. The results indicated that not even a single wellness program design is appropriate for all companies or even one company across all locations.
Research limitations/implications
Although there were no general conclusions have been drawn nor have the influencing factors for the different behaviors of the various target groups been adequately examined in this exploratory study, there were baselines developed for future research.
Originality/value
Few empirical studies exists that measure the perceived value of corporate wellness programs, especially among different cultural settings. In effect, wellness programs need to be developed specifically for the target population, with considerations to perceived value differences.
... Also, 38.3% of those in the experimental group reported partaking in physical activity by the one-year follow-up, which was 100% increase from the baseline 19 high-density lipoprotein cholesterol, diastolic blood pressure, health habits, and total health risk for those in the active intervention group 68 . 57% of employees, who were marked as high risk at the start of the intervention, were improved to low risk by the end of the program 68 . ...
... Also, 38.3% of those in the experimental group reported partaking in physical activity by the one-year follow-up, which was 100% increase from the baseline 19 high-density lipoprotein cholesterol, diastolic blood pressure, health habits, and total health risk for those in the active intervention group 68 . 57% of employees, who were marked as high risk at the start of the intervention, were improved to low risk by the end of the program 68 . Employees that participated in the intervention, saw a annual claim decrease of 48% one year after intervention, as opposed to employees who did not participate in the intervention, saw no change in annual claim costs 68 . ...
... 57% of employees, who were marked as high risk at the start of the intervention, were improved to low risk by the end of the program 68 . Employees that participated in the intervention, saw a annual claim decrease of 48% one year after intervention, as opposed to employees who did not participate in the intervention, saw no change in annual claim costs 68 . Ultimately, the worksite wellness intervention helped decrease employee health risk and annual claim costs 68 . ...
Purpose: The present study aimed to evaluate the effect of a financial incentive on weight loss and diabetes risk score (DRS) following a tailored National Diabetes Education Program (NDEP) weight loss intervention among adults who are overweight/obese and who are at risk for type 2 diabetes. An additional aim to evaluate changes in weight loss self-efficacy (WLSE), exercise self-efficacy (ESE), healthy eating score (HES) and movement through the stages of change (SOC) from pre to post intervention. Design: Four long-term care facilities, from one corporation, were randomly assigned to either an Incentivized Program (IP) or a Non-Incentivized Program (NIP). All facility employees were asked to follow a weight loss program for 16-weeks and a 3-month follow-up, with a goal of losing 1 or 1 ½ pounds a week. All had a one-on-one hour-long consultation session with a Registered Dietitian and/or Health Educator, which included setting weekly weight loss goals. IP participants could bank 160, but needed to lose a minimum weight (11 or 14 pounds) to receive any cash incentive. The IP group also could participate in “Win Big,” where participant’s weekly cash deposit with achieving weight loss goal was matched by the Program. IP participants who maintained the intervention weight loss at 3-months follow-up would receive an additional $100. The NIP participants received no financial incentive. Results: Seventy-three employees completed the 16 weeks program and 3-month follow-up; 35 from the IP group and 38 from the NIP group. Most were middle-ages females with at least a high school diploma. There was a significant weight loss for the IP group at the completion of the study compare to the NIP group (p<0.05). The mean weight loss for IP group was (Mean ± SE) 7.40 ± 1.88 pounds and for NIP group was (Mean ± SE) 2.17 ± 1.36 pounds. The total weight loss for the IP group was 304.8 pounds and the total weight loss for NIP group was 148.4 pounds. Neither group showed a significant reduction in BMI from pre-post intervention. Diabetes risk score also showed significant reduction in the IP group compare to the NIP group using nonparametric procedure (p<0.05). Percentage of participants in the IP group that improved in waist circumference was 80% compared to 73% of participants who improved in the NIP group. Overall SOC and HES scores increased for both groups, while overall WLSE and ESE scores from baseline to 3-month follow-up decreased for the IP group but remained unchanged for the NIP group. The IP group had a higher percentage of participants improve in almost all chronic conditions. Participants who lost at least 5% of weight had higher percentage of participants who improved in overall SOC (p value 0.04), WLSE, ESE, HES, waist circumference, self-reported general health, energy level, and almost all chronic conditions. Percentage of participants, who lost at least 5% of weight, that improved in waist circumference was 100% compared to 67.90% of participants who improved and did not lose at least 5% of weight. Conclusions: This study demonstrated the effectiveness of a monetary incentive in a weight loss program for individuals who are overweight and obese and at high risk for type 2 diabetes, based on weight and DRS. Those who lost 5% of weight showed higher improvements in overall SOC, WLSE, ESE, HES, waist circumference, self-reported general health, energy level, and almost all chronic conditions. Further testing of longer-term use of monetary incentives is needed to determine whether it would lead to sustained weight loss.
... For employers, maintaining the health of employees translates to reduced costs [4][5][6]. Studies have shown that poor health among employees leads to decreases in productivity and increased absenteeism [7][8][9][10]. Health promotion programs and the adoption of employer-paid or contributed health insurance can lead to decreased absenteeism and reduced costs for employers [4,[11][12][13][14]. ...
... None of the independent variables had a strong relationship with knowledge of a particular condition. Studies have shown some benefit to workplace wellness education programs in improvements on cardiac risk factors [6], obesity [14], cardiovascular disease and diabetes [33], and physical activity [34]. In general, Rula and Hobgood reported that "workplace health promotion programs founded on objective health metrics can motivate employee health-risk reduction" [35]. ...
... Work environments may provide a venue for screening and education regarding healthy lifestyles and behaviors. Research has shown that introducing wellness programs in the workplace can have benefits not only for the individual and their ability to maintain a healthy lifestyle and reduce risks for certain disease, but also as a way for employers to reduce costs related to absenteeism and lost productivity from illness [6,13,37]. Evidence for all three conditions shows that early intervention after diagnosis can significantly help prevent complications and progression [15,17,20], especially in an asymptomatic phase. These data could also be used to encourage employers to expand existing workplace programs focused on one disease to include education on other conditions and risk behaviors. ...
Introduction:
The burden of non-communicable diseases (NCDs) is growing in sub-Saharan Africa combined with an already high prevalence of infectious disease, like HIV. Engaging the formal employment sector may present a viable strategy for addressing both HIV and NCDs in people of working age. This study assesses the presence of three of the most significant threats to health in Namibia among employees in the formal sector: elevated blood pressure, elevated blood glucose, and HIV and assesses the knowledge and self-perceived risk of employees for these conditions.
Methods:
A health and wellness screening survey of employees working in 13 industries in the formal sector of Namibia was conducted including 11,192 participants in the Bophelo! Project in Namibia, from January 2009 to October 2010. The survey combined a medical screening for HIV, blood glucose and blood pressure with an employee-completed survey on knowledge and risk behaviors for those conditions. We estimated the prevalence of the three conditions and compared to self-reported employee knowledge and risk behaviors and possible determinants.
Results:
25.8% of participants had elevated blood pressure, 8.3% of participants had an elevated random blood glucose measurement, and 8.9% of participants tested positive for HIV. Most participants were not smokers (80%), reported not drinking alcohol regularly (81.2%), and had regular condom use (66%). Most participants could not correctly identify risk factors for hypertension (57.2%), diabetes (57.3%), or high-risk behaviors for HIV infection (59.5%). In multivariate analysis, having insurance (OR:1.15, 95%CI: 1.03 - 1.28) and a managerial position (OR: 1.29, 95%CI: 1.13 - 1.47) were associated with better odds of knowledge of diabetes.
Conclusion:
The prevalence of elevated blood pressure, elevated blood glucose, and HIV among employees of the Namibian formal sector is high, while risk awareness is low. Attention must be paid to improving the knowledge of health-related risk factors as well as providing care to those with chronic conditions in the formal sector through programs such as workplace wellness.
... In the face of rising healthcare costs in the United States, and the substantial proportion of those costs for which employers are responsible in the form of health insurance premiums and disability benefits, there is a growing body of literature addressing the impact of health risk factors and specific health conditions on employees' healthcare costs. In terms of direct healthcare costs, multiple studies have demonstrated the financial burden on employers resulting from employees' specific illnesses [12][13][14] or modifiable health risk factors [15][16][17][18]. Direct healthcare costs have been found to be correlated with the type and number of health risks [16,18,19]. ...
... Additional research has evaluated the impact of employee health on workplace productivity. Several studies have demonstrated associations between the presence of specific health conditions, [8,[12][13][14] or health risk factors [9,[20][21][22] and increased employee absence or disability. The presence of multiple risk factors has also been shown to affect the magnitude of productivity losses [23]. ...
... Data were extracted from the Truven Health MarketScan® Commercial Claims and Encounters (Commercial) and Health and Productivity Management (HPM) Databases. Data from these databases are the basis of over 700 peer-reviewed articles published in clinical, health policy, and health economics journals covering a wide range of therapeutic areas [14,[26][27][28][29]. ...
The high acute costs of cardiovascular disease and acute cardiovascular events are well established, particularly in terms of direct medical costs. The costs associated with lost work productivity have been described in a broad sense, but little is known about workplace absenteeism or short term disability costs among high cardiovascular risk patients. The objective of this study was to quantify workplace absenteeism (WA) and short-term disability (STD) hours and costs associated with cardiovascular events and related clinical procedures (CVERP) in United States employees with high cardiovascular risk.
Medical, WA and/or STD data from the Truven Health MarketScan® Research Databases were used to select full-time employees aged 18-64 with hyperlipidemia during 2002-2011. Two cohorts (with and without CVERP) were created and screened for medical, drug, WA, and STD eligibility. The CVERP cohort was matched with a non-CVERP cohort using propensity score matching. Work loss hours and indirect costs were calculated for patients with and without CVERP and by CVERP type. Wages were based on the 2013 age-, gender-, and geographic region-adjusted wage rate from the United States Bureau of Labor Statistics.
A total of 5,808 WA-eligible, 21,006 STD-eligible, and 3,362 combined WA and STD eligible patients with CVERP were well matched to patients without CVERP, creating three cohorts of patients with CVERP and three cohorts of patients without CVERP. Demographics were similar across cohorts (mean age 52.2-53.1 years, male 81.3-86.8 %). During the first month of follow-up, patients with CVERP had more WA/STD-related hours lost compared with patients without CVERP (WA-eligible: 23.4 more hours, STD-eligible: 51.7 more hours, WA and STD-eligible: 56.3 more hours) (p < 0.001). Corresponding costs were 683, 895, and $1,119 higher, respectively (p < 0.001). Differences narrowed with longer follow-up. In the first month and year of follow-up, patients with coronary artery bypass graft experienced the highest WA/STD-related hours lost and costs compared with patients with other CVERP.
CVERP were associated with substantial work loss and indirect costs. Prevention or reduction of CVERP could result in WA and STD-related cost savings for employers.
... The research in wellness program development and wellness interventions is not designed in a holistic or multidimensional wellness framework (Brubaker, Witta, & Angelopoulos, 2003;Hatch & Lusardi, 2010;Milani & Lavie, 2009;Palumbo, Wu, Shaner-McRae, Rambur, & McIntosh, 2012;Turner, Thomas, Wagner, & Moseley, 2008). Characteristically, prior research, almost exclusively, has targeted the physical dimension of wellness by improving nutrition or increasing physical activity (Brubaker et al., 2003;Hatch & Lusardi, 2010;Milani & Lavie, 2009;Palumbo et al., 2012;Turner et al., 2008). ...
... The research in wellness program development and wellness interventions is not designed in a holistic or multidimensional wellness framework (Brubaker, Witta, & Angelopoulos, 2003;Hatch & Lusardi, 2010;Milani & Lavie, 2009;Palumbo, Wu, Shaner-McRae, Rambur, & McIntosh, 2012;Turner, Thomas, Wagner, & Moseley, 2008). Characteristically, prior research, almost exclusively, has targeted the physical dimension of wellness by improving nutrition or increasing physical activity (Brubaker et al., 2003;Hatch & Lusardi, 2010;Milani & Lavie, 2009;Palumbo et al., 2012;Turner et al., 2008). Wellness is commonly operationalized using the SF-36 (Brubaker et al., 2003;Chafetz, White, Collins-Bride, Cooper, & Nickens, 2008;Hatch & Lusardi, 2010;Joslin, Lowe, & Peterson, 2006;Milani & Lavie, 2009;Palumbo et al., 2012;Turner et al., 2008). ...
... Characteristically, prior research, almost exclusively, has targeted the physical dimension of wellness by improving nutrition or increasing physical activity (Brubaker et al., 2003;Hatch & Lusardi, 2010;Milani & Lavie, 2009;Palumbo et al., 2012;Turner et al., 2008). Wellness is commonly operationalized using the SF-36 (Brubaker et al., 2003;Chafetz, White, Collins-Bride, Cooper, & Nickens, 2008;Hatch & Lusardi, 2010;Joslin, Lowe, & Peterson, 2006;Milani & Lavie, 2009;Palumbo et al., 2012;Turner et al., 2008). Although the 36-Item Short Form Health Survey (SF-36) is a valid and reliable measurement tool across general and specific populations, the tool is designed to compare the burden of disease and differentiate health benefits of specific treatments or interventions (Ware, 2011). ...
Background and Purpose: Nurse researchers and practicing nurses need reliable and valid instruments to measure key clinical concepts. The purpose of this research was to develop an innovative method to measure dimensions of wellness among older adults. Method: A sample of 5,604 community-dwelling older adults was drawn from members of the COLLAGE consortium. The Wellness Assessment Tool (WEL) of the COLLAGE assessment system provided the data used to create the scores. Application of the Rasch analysis and Masters' partial credit method resulted in logit values for each item within the five dimensions of wellness as well as logit values for each person in the sample. Results: The items fit the Rasch model, and the composite scores for each dimension demonstrated high reliability (1.00). The person reliability was low: social (.19), intellectual (.33), physical (.29), emotional (.20), and spiritual (.29). The small number of items within each dimension and the homogenous sample appear to have contributed to this low reliability. Conclusion: Ongoing research using multidimensional tools to measure dimensions of wellness among older adults is needed to advance wellness science and wellness promotion in nursing practice.
... For example, interventions in Asia that tried to increase capability were usually successful in helping people quit smoking, while European interventions were not. The literature shows that while smoking is no longer socially acceptable in North America and Europe [152,153], for DIET Opportunity -Access 11 [56,61,63,82,83,92,95,96,103,119,121] 9 (82%) [56,61,63,82,83,92,95,96,103] Opportunity -Changing Physical and/or Social Environment 11 [40,56,61,71,83,96,103,105,118,120,121] 8 (73%) [40,56,61,71,83,96,103,105] Opportunity -Social Support 14 [54,55,65,75,82,96,101,103,105,119,[123][124][125]127] 9 (64%) [54,55,65,75,82,96,101,103,105] PHYSICAL ACTIVITY Opportunity -Access 12 [49,56,61,63,82,83,92,95,96,103,119,121] 10 (83%) [49,56,61,63,82,83,92,95,96,103] Opportunity -Changing Physical and/or Social Environment 11 [40,56,61,71,83,96,103,105,118,120,121] 8 (73%) [40,56,61,71,83,96,103,105] Opportunity -Social Support 15 [51,54,55,65,75,82,96,101,103,105,119,[123][124][125]127] 10 (67%) [51, 54, 55, 65, 75, 82, 96, The mechanisms within these interventions may not be exclusively for addressing smoking behaviour. It could be part of the overall intervention or for other risk behaviours within that intervention b This category examines interventions that include the specific risk behaviour (i.e. ...
... For example, interventions in Asia that tried to increase capability were usually successful in helping people quit smoking, while European interventions were not. The literature shows that while smoking is no longer socially acceptable in North America and Europe [152,153], for DIET Opportunity -Access 11 [56,61,63,82,83,92,95,96,103,119,121] 9 (82%) [56,61,63,82,83,92,95,96,103] Opportunity -Changing Physical and/or Social Environment 11 [40,56,61,71,83,96,103,105,118,120,121] 8 (73%) [40,56,61,71,83,96,103,105] Opportunity -Social Support 14 [54,55,65,75,82,96,101,103,105,119,[123][124][125]127] 9 (64%) [54,55,65,75,82,96,101,103,105] PHYSICAL ACTIVITY Opportunity -Access 12 [49,56,61,63,82,83,92,95,96,103,119,121] 10 (83%) [49,56,61,63,82,83,92,95,96,103] Opportunity -Changing Physical and/or Social Environment 11 [40,56,61,71,83,96,103,105,118,120,121] 8 (73%) [40,56,61,71,83,96,103,105] Opportunity -Social Support 15 [51,54,55,65,75,82,96,101,103,105,119,[123][124][125]127] 10 (67%) [51, 54, 55, 65, 75, 82, 96, The mechanisms within these interventions may not be exclusively for addressing smoking behaviour. It could be part of the overall intervention or for other risk behaviours within that intervention b This category examines interventions that include the specific risk behaviour (i.e. ...
Background:
Smoking continues to be a leading cause of preventable chronic disease-related morbidity and mortality, excess healthcare expenditure, and lost work productivity. Tobacco users are disproportionately more likely to be engaging in other modifiable risk behaviours such as excess alcohol consumption, physical inactivity, and poor diet. While hundreds of interventions addressing the clustering of smoking and other modifiable risk behaviours have been conducted worldwide, there is insufficient information available about the context and mechanisms in these interventions that promote successful smoking cessation. The aim of this rapid realist review was to identify possible contexts and mechanisms used in multiple health behaviour change interventions (targeting tobacco and two or more additional risk behaviours) that are associated with improving smoking cessation outcome.
Methods:
This realist review method incorporated the following steps: (1) clarifying the scope, (2) searching for relevant evidence, (3) relevance confirmation, data extraction, and quality assessment, (4) data analysis and synthesis.
Results:
Of the 20,423 articles screened, 138 articles were included in this realist review. Following Michie et al.'s behavior change model (the COM-B model), capability, opportunity, and motivation were used to identify the mechanisms of behaviour change. Universally, increasing opportunities (i.e. factors that lie outside the individual that prompt the behaviour or make it possible) for participants to engage in healthy behaviours was associated with smoking cessation success. However, increasing participant's capability or motivation to make a behaviour change was only successful within certain contexts.
Conclusion:
In order to address multiple health behaviours and assist individuals in quitting smoking, public health promotion interventions need to shift away from 'individualistic epidemiology' and invest resources into modifying factors that are external from the individual (i.e. creating a supportive environment).
Trial registration:
PROSPERO registration number: CRD42017064430.
... Previously, PA and/or sedentary behaviours were examined within a university setting due to the substantial number of working hours completed by employees and limited time to undertake PA, a significant barrier reported for PA participation [7,[11][12][13][14]. This setting exemplifies the typical white collar workplace where there has been a focus on employee productivity and/or health [15][16][17][18][19] via examination of PA, sedentary behaviours, and quality of life (QOL) [11,12,[20][21][22]. ...
... This was unexpected given the similarity in demographics between cohorts, the lower PA and greater sedentary behaviour of the follow-up cohort, and the significant and negative associations between mental health indices (MH and MCS) and total sitting time for the initial and follow-up cohorts [7]. An explanation for this result was not obvious but may be related to the greater moderate PA levels for the follow-up cohort with moderate intensity PA demonstrated to enhance mental well-being [20,22]. Future studies may elucidate the relative contributions of sedentary behaviour and PA on both physical and mental health of employees including changes with workplace PA and/or sitting interventions. ...
Abstract Background Interventions to increase physical activity and reduce sedentary behaviours within the workplace have been previously investigated. However, the evolution of these constructs without intervention has not been well documented. This retrospective study explored the natural progression or time kinetics of physical activity, sedentary behaviours and quality of life in a professional skilled workplace where focussed interventions were lacking. Methods Participants (n = 346) employed as full-time staff members at a regional university completed an online survey in 2013 assessing physical activity and sedentary behaviours via the International Physical Activity Questionnaire, and quality of life via the Short-Form 36v2 questionnaire. Differences between that cohort of participants and an initial sample of similar participants (2009, n = 297), accounting for gender and staff categories (academic vs. professional), were examined using ANCOVAs with working hours as a co-variate. Results In comparison to the initial cohort, the follow-up cohort reported significantly less leisure-time, total walking, total vigorous and total physical activity levels, and lower overall physical health for quality of life (p
... Programs consisted of online health promotion tools, 45 coaching and counseling sessions, and on-site health management classes. [46][47][48][49][50] Effects of these programs included a reduction in direct medical costs ranging from $176 to $1,539 per participant per year. 46,47,51 Other studies took a broader view on costs and found $613 in savings when including disability cost savings 48 and $180 in savings when combining health care costs and absenteeism. ...
... [46][47][48][49][50] Effects of these programs included a reduction in direct medical costs ranging from $176 to $1,539 per participant per year. 46,47,51 Other studies took a broader view on costs and found $613 in savings when including disability cost savings 48 and $180 in savings when combining health care costs and absenteeism. 52 ...
This article describes the current state of workplace wellness programs in the United States, including typical program components; assesses current uptake among U.S. employers; reviews the evidence for program impact; and evaluates the current use and the impact of incentives to promote employee engagement. Wellness programs have become very common, as 92 percent of employers with 200 or more employees reported offering them in 2009. Survey data indicate that the most frequently targeted behaviors are exercise (addressed by 63 percent of employers with programs), smoking (60 percent), and weight loss (53 percent). In spite of widespread availability, the actual participation of employees in such programs remains limited. A 2010 survey suggests that typically less than 20 percent of eligible employees participate in wellness interventions. At this time, it is difficult to definitively assess the impact of workplace wellness on health outcomes and cost. While employer sponsors are mostly satisfied with the results, more than half stated in a recent survey that they did not know their program's return on investment. The peer-reviewed literature, while predominately positive, covers only a tiny percentage of the universe of programs. Evaluating such complex interventions is difficult and poses substantial methodological challenges that can invalidate findings. The use of incentives, such as cash, cash equivalents, and variances in health plan costs, to promote employee engagement, while increasingly popular, remains poorly understood. Future research should focus on finding out which wellness approaches deliver which results under which conditions to give much-needed guidance on best practices.
... Interestingly, regardless of the proven effectiveness of worksite health interventions in diminishing multiple health risk factors, increasing productivity, minimizing absenteeism, and decreasing health care costs [17,[25][26][27] as well as the research efforts to improve the health and well-being of healthcare workers, the acute and long term sickness absence, in particular scenarios, remains high [28]. Similarly, a recent systematic review of literature on worksite-based diet/physical activity interventions showed that the most effective methods tended to be the costliest in terms of both time and resources [29], which is potentially problematic when it comes to implementing them in a wider range of work setups. ...
Objective:
To identify the effect of workplace health promotion activities (WHPA) on the health status of health personnel.
Methodology:
A systematic literature review was performed. Six computerized databases were used to search for studies on the effect of at least one health promotion activity on the health status of health personnel. Studies were included if they were published in peer-reviewed and indexed journals and were written either in English, Spanish, or Portuguese. Information such as study population, sample size, type of study, outcome, and health promotion activities performed were extracted from each publication. All the included articles were measured in terms of their methodological quality, including the risk of bias.
Results:
Lower scores on perceived stress, emotional exhaustion, and mood symptoms were reported. An improvement in sleep hours and quality and a reduction in dietary sodium intake were informed. Improvements in participants’ dietary habits, weight loss, and body fat percentage, along with increased physical activity and a reduction in pain levels were reported. A reduction in the prevalence of cigarette smoking was found.
Conclusions:
WHPAs can enhance physical and mental health, and overall well-being, and encouraging healthier behaviors among health personnel. Most of the studies targeting mental health focused their efforts primarily on reducing healthcare workers’ perceived stress. WHPAs that addressed both diet and physical activity behaviors were more effective at improving weight outcomes than those that used only one approximation. Overall, this study offers valuable information on the impact of worksite-based health promotion interventions, including the effect of different strategies applied.
... Increases in health care expenditures are of concern for the global economy and global health because they question and challenge the financial capacity of governments to provide sufficient, fair, and safe health care services for the general population (Meskarpour Amiri et al., 2021). Analyzing or replicating modifiable risk factors and environmental variables at a global and macro-political level is crucial for the development and application of health intervention and prevention models that improve health care expenditures while maintaining the quality of public medical services (Milani and Lavie, 2009). In addition, the incorporation of the analysis of environmental variables would also allow the identification of sustainable development goals (SDGs) that would be useful for the implementation of public health prevention policies (Sharma et al., 2021). ...
Increases of health care expenditures (HCEs) challenge the financial capacity of governments and bring into question the quality of health care services in each country. It is known that modifiable risk factors (e.g. alcohol consumption) and certain environmental variables allow HCEs to be modeled without impairing the quality of healthcare services. We provide a worldwide statistical analysis of how HCEs can be reduced and with what statistical power/probability. The design was retrospective and was based on linear and nonlinear multiple regression models. The HCEs, alcohol consumption, renewable energy consumption, suicide rate, economic reversal of the environmental damage caused by CO2 emissions (ERCDE) and sales-focused jobs (SJs) were measured. The type of government and the most searched Twitter worldwide topics were also analyzed. A total of 154 countries (n) participated. Reducing alcohol consumption, SJs and ERCDE predicts linear reductions of 33.1% of HCEs. Annual alcohol consumption between 4 and 5 L per person was found to have no negative impact on HCEs. Beyond this tipping point, alcohol consumption did predict significant increases in HCEs. It was also found that renewable energy consumption exponentially explained 35.2% of the reductions in HCEs. HCEs can be reduced in each country by controlling the consumption of renewable energies, the ERCDE, and the SJs. Specifically, by controlling alcohol consumption, SJs, and ERCDE the economic reduction in HCEs could be reduced annually by as much as $228.466 per person. We offer tipping points that governments can use to make effective health policy decisions that include sustainable development goals.
... During the past decade, the importance of periodic wellness assessments, health screening, and healthy habits has become apparent since they not only reduce the risks of various diseases by allowing improved surveillance 1,2 but also decrease associated health care costs. [3][4][5][6][7][8][9][10][11] Wellness, preventive health care, 12,13 and healthy lifestyles are associated with improving various diseases and underlying conditions, [14][15][16][17][18] and the rate of morbidity may be decreased by embracing healthy lifestyles as recommended by health care providers. [19][20][21][22][23][24][25] In 2011, the value of wellness promotion was emphasized when Medicare created the annual wellness visit for health assessments and personal prevention plans. ...
Background
We previously reported on a pilot study to assess the incorporation of a novel wellness assessment device, the Preventiometer (iPEx5 GmbH, Greifswald, Germany), into an academic medical practice. The present follow-up study expands on those data and evaluates the acceptability of the assessment process in a larger sample population.
Objective
The aim of this study was to evaluate participant satisfaction with the Preventiometer wellness assessment.
Methods
A total of 60 healthy volunteers participated. Each participant underwent a comprehensive wellness assessment with the Preventiometer and received data from more than 30 diagnostic tests. A 32-question survey (with a numeric rating scale from 0 to 10) was used to rate the wellness assessment tests and participants’ impressions of the wellness assessment.
Results
Each assessment had a significantly higher rating than 7 ( P < .001), and the majority of participants agreed or strongly agreed that they were satisfied (98.3%), and they strongly agreed that they were engaged the entire time (93.2%), and liked the instant test results feature of the Preventiometer device (93.2%).
Conclusion
This study confirms findings from our previous pilot study regarding the feasibility of the Preventiometer as a wellness assessment tool. The study further demonstrated that 98% of participants were satisfied with the assessment and that all of them would recommend it to others.
... Studies have documented worksite wellness programs (WWP) as an important strategy in overall health prevention and promotion (Carnethon et al., 2009;Milani & Lavie, 2009;Osilla et al., 2102;Webber et al., 2012). WWPs are positioned to provide population-based strategies toward meeting AHA Impact Goals. ...
Background: Cardiovascular disease (CVD) is the number one cause of death in the United States with risk factors including hypertension, hyperlipidemia, diabetes, obesity, smoking, physical inactivity, age, genetics, and unhealthy diets. A university-based workplace wellness program (WWP) consisting of an annual biometric screening assessment with targeted, individualized health coaching was implemented in an effort to reduce these risk factors while encouraging and nurturing ideal cardiovascular health.
Objective: The purpose of this study was to examine and describe the prevalence of single and combined, or multiple, CVD risk factors within a workplace wellness dataset.
Methods: Cluster analysis was used to determine CVD risk factors within biometric screening data (BMI, waist circumference, LDL, total cholesterol, HDL, triglycerides, blood glucose age, ethnicity, and gender) collected during WWP interventions.
Results: The cluster analysis provided visualizations of the distributions of participants having specific CVD risk factors. Of the 8,802 participants, 1,967 (22.4%) had no CVD risk factor, 1,497 (17%) had a single risk factor, and 5,529 (60.5%) had two or more risk factors. The majority of sample members are described as having more than one CVD risk factor with 78% having multiple.
Conclusion: Cluster analysis demonstrated utility and efficacy in categorizing participant data based on their CVD risk factors. A baseline analysis of data was captured and provided understanding and awareness into employee health and CVD risk. This process and analysis facilitated WWP planning to target and focus on education to promote ideal cardiovascular health.
... Precisely, this concern should focus on the impact of employee health on workplace productivity and its potential loss which is related with specific health factors conditions especially among CVD (Leal et al., 2006;Song et al., 2015). Therefore, the management and prevention of CVD should become first health priority imposed on governments and politics regardless geographic area (Milani and Lavie, 2009). ...
Background
Cardiovascular diseases are associated with growing public and private expenditure on healthcare regardless geographic region. Therefore, it is necessary to accurately estimate the overall societal costs—both direct and indirect expenses from the perspective of patients, caregivers and employers.
Research Design
The aim of this paper is to determine the direct and indirect costs related to cardiovascular diseases in Poland from 2015 to 2017. All costs are estimated based on data available in the public domain and obtained from the major Polish institutions. Indirect costs were calculated using a modified human capital approach.
Results
The financial burden of cardiovascular diseases in Poland is significant. This study revealed that total costs (direct and indirect) of cardiovascular diseases, for 2015–2017, range from 34.9 bn PLN (8.2 bn EUR) to over 40.9 bn PLN (9.6 bn EUR). Total direct cost and indirect costs were approximately 6.1 bn PLN (1.4 bn EUR) (16%) and 31.3 bn PLN (7.3 bn EUR) (84%), respectively.
Conclusion
Collectively, the estimated direct and indirect cost of cardiovascular diseases provide a useful input for economic impact assessments of public health programs and health technology analyses.
... In several investigations, levels of anxiety, depression, somatization, and hostility significantly decreased, according to the SQ scales and subscales, in different subgroups of patients undergoing cardiac or pulmonary rehabilitation [67-70, 72, 78, 80-87, 189-196], and among employees receiving a worksite health intervention [197]. In some of these studies, the SQ significantly discriminated between different degrees of improvement among subgroups of coronary artery disease patients [72,78,82,84,87,191,195]. ...
Introduction:
Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment.
Objective:
The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being).
Methods:
The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included.
Results:
A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo.
Conclusions:
The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.
... The studies used different types of interventions like campaigns, workshops and education; individual level behavioral change; and changes to the office environment and policies. Out of the 33 studies reviewed, 28 studies [32,36,37,[39][40][41][42][43][44][45][46][47][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] used a mix of the three approaches whereas the other 5 studies [33-35, 38, 48] implemented any one of these three approaches. The intervention duration in all the studies ranged from 6 months to 5 years. ...
Background:
Adults in urban areas spend almost 77% of their waking time being inactive at workplaces, which leaves little time for physical activity. The aim of this systematic review and meta-analysis was to synthesize evidence for the effect of workplace physical activity interventions on the cardio-metabolic health markers (body weight, waist circumference, body mass index (BMI), blood pressure, lipids and blood glucose) among working adults.
Methods:
All experimental studies up to March 2018, reporting cardio-metabolic worksite intervention outcomes among adult employees were identified from PUBMED, EMBASE, COCHRANE CENTRAL, CINAHL and PsycINFO. The Cochrane Risk of Bias tool was used to assess bias in studies. All studies were assessed qualitatively and meta-analysis was done where possible. Forest plots were generated for pooled estimates of each study outcome.
Results:
A total of 33 studies met the eligibility criteria and 24 were included in the meta-analysis. Multi-component workplace interventions significantly reduced body weight (16 studies; mean diff: - 2.61 kg, 95% CI: - 3.89 to - 1.33) BMI (19 studies, mean diff: - 0.42 kg/m2, 95% CI: - 0.69 to - 0.15) and waist circumference (13 studies; mean diff: - 1.92 cm, 95% CI: - 3.25 to - 0.60). Reduction in blood pressure, lipids and blood glucose was not statistically significant.
Conclusions:
Workplace interventions significantly reduced body weight, BMI and waist circumference. Non-significant results for biochemical markers could be due to them being secondary outcomes in most studies. Intervention acceptability and adherence, follow-up duration and exploring non-RCT designs are factors that need attention in future research. Prospero registration number: CRD42018094436.
... Programs targeted to prevention of CVD should provide substantial overall cost savings. 52,53 Studies with statins 54 have previously reported that prevention or reduction in CVD events results in overall cost savings, and it is possible that PCSK9 inhibitors could reduce CVD events a further 15%-20% beyond statin therapy. 13,15,20 Estimating from our data, if CVD were reduced by 15% 20 then CVD care would save $67 billion. ...
Background
Proprotein convertase subtilisin/kexin type 9 inhibitors, Praluent (alirocumab [ALI]) and Repatha (evolocumab [EVO]) have been approved as adjuncts to the standard-of-care maximal-tolerated dose (MTD) of low-density lipoprotein cholesterol (LDLC)-lowering therapy (LLT), statin therapy, in heterozygous (HeFH) (ALI or EVO) or homozygous (EVO) familial hypercholesterolemia, or clinical atherosclerotic cardiovascular disease (CVD) where LDLC lowering is insufficient (both). Since LDLC lowering has been revolutionized by ALI and EVO, specialty pharmaceutical pricing models will be applied to a mass market.
Methods
We applied US Food and Drug Administration (FDA) and insurance eligibility criteria for ALI and EVO to 1090 hypercholesterolemic patients serially referred over 3 years who then received ≥2 months maximal-tolerated dose of standard-of-care LDL cholesterol-lowering therapy (MTDLLT) with follow-up LDLC ≥70 mg/dL. MTDLLT did not include ALI or EVO, which had not been commercially approved before completion of this study.
Results
Of the 1090 patients, 140 (13%) had HeFH by clinical diagnostic criteria and/or CVD with LDLC >100 mg/dL despite ≥2 months on MTDLLT, meeting FDA insurance criteria for ALI or EVO therapy. Another 51 (5%) patients were statin intolerant, without HeFH or CVD.
Conclusion
If 13% of patients with HeFH-CVD and LDLC >100 mg/dL despite MTDLLT are eligible for ALI or EVO, then specialty pharmaceutical pricing models (~$14,300/year) might be used in an estimated 10 million HeFH-CVD patients. Whether the health care savings arising from the anticipated reduction of CVD events by ALI or EVO justify their costs in populations with HeFH-CVD and LDLC >100 mg/dL despite MTDLLT remains to be determined.
... If, speculatively, CVD and stroke incidence could be halved by PCSK9 therapy [11,14,16], direct annual savings would be estimated to be $160 billion, and indirect annual savings might be $85 billion [21], altogether $245 billion savings, in the middle of the range of estimated PCSK9 inhibitor costs of $185-342 billion [17]. Programs targeted to prevention of CVD should provide substantial overall cost savings [23,24]. ...
BackgroundPCSK9 inhibitor therapy has been approved by the FDA as an adjunct to diet-maximal tolerated cholesterol lowering drug therapy for adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease (ASCVD) with suboptimal LDL cholesterol (LDLC) lowering despite maximal diet-drug therapy. With an estimated ~24million of US hypercholesterolemic patients potentially eligible for PCSK9 inhibitors, costing ~ 8,904,361 (4,575,738 indirect), the median 10-year risk of a new CVD event was calculated to be 13.1 % with total cost 4,452,180 would have been saved in the past; and future 10-year savings would be 7,000 in the past, with future 10-year intervention net costs/patient/year being 50,000/year quality adjusted life-year gained by PCSK9 inhibitor therapy.
... Employers in the U.S. lose over $200 billion annually from health related productivity loses [22] and approximately 7% of these employers provide their employees with comprehensive workplace wellness programs [23]. Research has shown that these programs are an effective way to reduce the burden of CVD [24,25] and employers who invest in them improve employee health and productivity and save $3 to $15 for every dollar spent [6,26] Our large sample size and the use of standardized methods to collect data on the CVH metrics are strengths of this study. However, our study has some limitations. ...
... Real indirect costs (due to lost productivity) for all CVD are estimated to increase from $172 billion in 2010 to $276 billion in 2030, an increase of 61 % [23]. Programs targeted to prevention of CVD should provide substantial overall cost savings [25,26]. Given current pricing of $14,000-14,600 per patient per year, annual PCSK9 inhibitor costs might approximate $185-$342 billion, reflecting the use of a currently expensive drug for an endemic disease, CVD, the leading cause of mortality in the USA [23,27]. ...
LDL cholesterol (LDLC) lowering has been revolutionized by PCSK9 inhibitors, Alirocumab (Praluent) and Evolocumab (Repatha), approved as adjuncts to maximally tolerated cholesterol lowering therapy in heterozygous (HeFH) or homozygous (HoFH) familial hypercholesterolemia, and/or clinical atherosclerotic cardiovascular disease (CVD) where LDLC lowering is insufficient.
We applied FDA and insurance eligibility criteria for PCSK9 inhibitor use in 734 hypercholesterolemic patients serially referred over 3 years who then received ≥ 2 months maximally tolerated LDLC lowering therapy with follow up LDLC ≥ 70 mg/dl, and in 50 patients approved by insurance for PCSK9 inhibitors. We documented the percentage of patients with HeFH and/or CVD who met FDA and insurance criteria for PCSK9 inhibitor therapy using LDLC goal-based guidelines.
Of 734 patients with LDLC ≥ 70 mg/dl after ≥ 2 months maximally tolerated LDLC lowering therapy, 220 (30 %) had HeFH and/or CVD with LDLC > 100 mg/dl, meeting FDA-insurance criteria for PCSK9 inhibitor therapy. Another 66 (9 %) patients were statin intolerant, without HeFH or CVD. Of the 50 patients whose PCSK9 inhibitor therapy was approved for insurance coverage, 45 (90 %) had LDLC > 100 mg/dl after ≥ 2 months on maximally tolerated LDLC lowering therapy. Seventeen of these 50 patients (34 %) had HeFH without CVD (LDLC on treatment 180 ± 50 mg/dl), 15 (30 %) had CVD without HeFH (LDLC on treatment 124 ± 26 mg/dl), 14 (28 %) had both HeFH and CVD (LDLC on treatment 190 ± 53 mg/dl), and 4 (8 %) had neither HeFH nor CVD (LCLC 142 ± 11 mg/dl).
Of 734 patients referred for LDLC reduction, with LDLC ≥ 70 mg/dl after ≥ 2 months on maximally tolerated therapy, 220 (30 %) had HeFH and/or CVD with LDLC > 100 mg/dl, meeting FDA-insurance criteria for PCSK9 inhibitor therapy as an adjunct to diet-maximally tolerated cholesterol lowering therapy in HeFH or CVD. If 30 % of patients with high LDLC and HeFH-CVD are eligible for PCSK9 inhibitors, then specialty pharmaceutical pricing models (~245 billion, in the middle of the range of estimated PCSK9 inhibitor costs of $185-342 billion. Whether the health care savings arising from the anticipated reduction of CVD events by PCSK9 inhibitors justify their extraordinary costs in broad population use remains to be determined.
... The self-testing workplace stations may encourage employees to modify their unhealthy behaviors; thus, if combined with other wellness programs (smoking cessation, physical activity, or diet interventions), the wellness programs may produce even better outcomes. Milani and Lavie (2009) found that the worksite intervention, consisting of smoking cessation, fitness counseling, nutritional education, weight control, and treatment for drug and alcohol addiction, produced better health outcomes, resulting in more than half of high risk workers being converted to a low risk status, as well as enhanced health-related quality of life. ...
The objective of this secondary data analysis of cross-sectional data was to explore smoking behavior among blue collar workers, especially Operating Engineers (heavy equipment operators). With the guidance of the Health Promotion Model, the specific aims were (1) to determine variables associated with smoking behavior among Operating Engineers, (2) to examine smoking as one of the variables related to sleep quality among Operating Engineers, and (3) to examine smoking as one of the variables related to health-related quality of life among Operating Engineers. Working with Michigan Operating Engineers Local 324, data were collected until a quota of 500 participants was reached in 2008. Two surveys were incomplete, leading to the final sample of 498. Data contained demographic information, health conditions (depressive symptoms and medical comorbidities), health behaviors (smoking, alcohol use, diet, physical activity, and sleep), and health-related quality of life. Linear and logistic regression analyses were used to analyze the data. About 29% of the participants smoked cigarettes and smoking behavior was significantly associated with engaging in other high risk health behaviors (problem drinking, physical inactivity, and a lower BMI). This supported findings from a 2009 NIH meeting on the Science of Behavior Change that risky health behaviors often bundle together. In addition, smokers with nicotine dependence had poorer sleep quality and poor health-related quality of life among Operating Engineers. Considering the bundled health behaviors among smokers, multiple health behavior interventions would be more beneficial for Operating Engineers than single health behavior interventions. When designing multiple health behavior interventions, researchers should consider the pivotal role of smoking behavior in bundled health behaviors and view smoking cessation as a gateway to changing other risky health behaviors. Furthermore, multiple health behavior interventions combined with smoking and other risky health behaviors could improve health-related quality of life among Operating Engineers.
... Real indirect costs (due to lost productivity) for all CVD are estimated to increase from $172 billion in 2010 to $276 billion in 2030, an increase of 61 % [23]. Programs targeted to prevention of CVD should provide substantial overall cost savings [25,26]. Given current pricing of $14,000-14,600 per patient per year, annual PCSK9 inhibitor costs might approximate $185-$342 billion, reflecting the use of a currently expensive drug for an endemic disease, CVD, the leading cause of mortality in the USA [23,27]. ...
Background: LDL cholesterol (LDLC) lowering has been revolutionized by PCSK9 inhibitors, Alirocumab (Praluent) and Evolocumab (Repatha), approved as adjuncts to maximally tolerated cholesterol lowering therapy in heterozygous (HeFH) or homozygous (HoFH) familial hypercholesterolemia, and/or clinical atherosclerotic cardiovascular disease (CVD) where LDLC lowering is insufficient.
... Worksite health interventions such as wellness programs, fitness facilities, and educational programs are not novel. Such interventions have shown effectiveness in decreasing various health risk factors, increasing productivity, minimizing short-term absenteeism, and even decreasing employee's health care costs [4][5][6][7] . In assessing employees in a health care setting, the Behavioral Risk Factor Surveillance System (BRFSS), which included more than 21,000 healthcare workers, found that healthcare workers have a prevalence of smoking and obesity similar to non-health care workers 8 . ...
Worksite health interventions are not novel but their effect remains subject of debate. We examined employer-based wellness program to determine health habits trends, and compare prevalence estimates to national data. We conducted serial surveys (1996 and 2007–10) to employees of a large medical center that included questions measuring outcomes, including obesity, regular exercise, cardiovascular activity, and smoking status. Logistic regression models were estimated to compare data by membership across years, considering p-values ≤ 0.01 as statistically significant. 3,206 employees responded (Response rates 59–68%). Obesity prevalence increased over time in members and nonmembers of the wellness facility, consistent with national trends. Members had a lower prevalence of cigarette smoking compared to nonmembers (overall year-adjusted odds ratio 0.66, P < 0.001). Further, employees had a lower prevalence of cigarette smoking (9.7 vs. 17.3% in 2010, P < 0.001) compared with national data. Wellness facility membership was associated with increased regular exercise and cardiovascular exercise (P < 0.001) compared to nonmembers. In summary, working in a medical center was associated with a decreased prevalence of cigarette smoking, but not with lower prevalence of obesity. Worksite wellness facility membership was associated with increased exercise and decreased cigarette smoking. Employer-based interventions may be effective in improving some health behaviors.
... WWPs-where health promotion is integrated into the workplace environment and culture 10 -have been shown to positively influence health outcomes and factors. 11,12 WWPs are growing in popularity, and the body of evidence to support the effectiveness of such programs is growing as well. [13][14][15] Widespread adoption of WWPs is related to success in improving the health outcomes of employee populations as well as the associated insurance premium savings 16 and the return on investment for the company. ...
Purpose
To determine the barriers and facilitators associated with willingness to use personal health information management (PHIM) systems to support an existing worksite wellness program (WWP).
Design
The study design involved a Web-based survey.
Setting
The study setting was a regional hospital.
Subjects
Hospital employees comprised the study subjects.
Measures
Willingness, barriers, and facilitators associated with PHIM were measured.
Analysis
Bivariate logit models were used to model two binary dependent variables. One model predicted the likelihood of believing PHIM systems would positively affect overall health and willingness to use. Another predicted the likelihood of worrying about online security and not believing PHIM systems would benefit health goals.
Results
Based on 333 responses, believing PHIM systems would positively affect health was highly associated with willingness to use PHIM systems (p < .01). Those comfortable online were 7.22 times more willing to use PHIM systems. Participants in exercise-based components of WWPs were 3.03 times more likely to be willing to use PHIM systems. Those who worried about online security were 5.03 times more likely to believe PHIM systems would not help obtain health goals.
Conclusions
Comfort with personal health information online and exercise-based WWP experience was associated with willingness to use PHIM systems. However, nutrition-based WWPs did not have similar effects. Implementation barriers relate to technology anxiety and trust in security, as well as experience with specific WWP activities. Identifying differences between WWP components and addressing technology concerns before implementation of PHIM systems into WWPs may facilitate improved adoption and usage.
... 21 Entretanto, apesar destas evidencias positivas, ainda existe certa resistência por parte de algumas empresas no sentido de fomentar estes programas, devido a preocupações sobre como recuperar os custos com os mesmos. 26 De acordo com o American Institute of Stress, as indústrias americanas perdem cerca de 300 bilhões de dólares ao ano, devido a fatores relacionados com falta ao trabalho por parte de seus funcionários. 27 Este fato justifica a necessidade de criar uma estratégia para amenizar estes custos, com iniciativas que beneficiem finaceiramente as empresas. ...
Several studies have shown that physically active people enjoy better quality of life. As such, there are several exercise programs aimed towards health promotion and wellness in diferente kinds of industries around the world. These programs promote the practice of physical exercise in the workplace and some use resistance exercise (RE) as an important "tool" to promote strength gain, increase muscle mass, reduce body fat, improve cardiorespiratory system, and reduce depression and anxiety, contributing to overall improvement of physical fitness and health. However, the success of RE programs depends on some important variables such as the weekly training frequency and is associated to adherence of participants to the program. The propose of study was investigate what physical exercises and weekly frequencies are more reports in literature, aiming wellness and general health and still the factors of adherence to physical exercises in the health and wellness centers. For this a bibliographic search on different kinds of scientific publications (books, thesis, websites and articles) was realized. Initially, 267 studies between 2004 and 2015 were found and the titles and summaries were read. From these, 82 articles that demonstrated suficiente information were read in entirety. After completing readings and determining eligible criteria for referencing, 39 published studies between 2004 and 2015 were selected. It can be concluded that a training frequency of twice per week promotes the development of health and wellness and is also more commonly practiced in workplace RE programs.
Keywords: resistance exercise, health, weekly frequency, adherence and workplace.
... 3 However, single cardiovascular risk factors are still being measured without being part of a structured risk management programme, for example in occupational health, for research purposes, or in incidentally offered health checkups at pharmacies or by private companies. [4][5][6] In the Netherlands, every year 1,875,000 individuals undergo health checks outside primary care. 7 In addition, another 317,000 individuals are involved each year in research 8 in which risk factors are often measured. ...
Background:
In contrast to structured, integrated risk assessment in primary care, unstructured risk factor screening outside primary care and corresponding recommendations to consult a general practitioner (GP) are often based on one abnormal value of a single risk factor. This study investigates the advantages and disadvantages of unstructured screening of blood pressure and cholesterol outside primary care.
Methods:
After the baseline visit of the Netherlands Epidemiology of Obesity study (population-based prospective cohort study in persons aged 45-65 years, recruited 2008-2012) all participants received a letter with results of blood pressure and cholesterol, and a recommendation to consult a GP if results were abnormal. Four years after the start of the study, participants received a questionnaire about the follow-up of their results.
Results:
The study population consisted of 6343 participants, 48% men, mean age 56 years, mean body mass index 30 kg/m(2). Of all participants 66% had an abnormal result and, of these, 49% had a treatment indication based on the risk estimation system SCORE-NL 2006. Of the 25% of the participants who did not consult a GP, 40% had a treatment indication. Of the participants with an abnormal result 19% were worried, of whom 60% had no treatment indication.
Conclusions:
In this population 51% of the participants with an abnormal result had unnecessarily received a recommendation to consult a GP, and 10% were unnecessarily worried. GPs should be informed about the complete risk assessment, and only participants at intermediate or high risk should receive a recommendation to consult a GP.
... In addition to the aspects of employees' health, elevated MSC is associated with increased medical costs [70,71]. Milani et al. reports decreased total health risk and markedly reduced medical claim costs through worksite health programs [72]. Whether RSW significantly inflates economic burden in workplaces in Taiwan, and whether reductions of MSCD lower medical costs among workers are interesting issues for further investigation. ...
To establish a practical method for assessing the general metabolic health conditions among different employee groups, this study utilized the total count of metabolic syndrome (MetS) elements as a parameter, and performed a retrospective analysis comparing changes of MetS component count (MSC) of 5 years among day-time work (DW) and day-andnight rotating shift work (RSW) employees.
The data of personal histories, physical examinations, blood tests, abdominal sonographic examinations and occupational records were collected from a cohort of workers in an electronics manufacturing company. We first defined the arithmetic mean value of MSC as MSC density (MSCD) for the employee group; then we compared the changes of MSCD over 5 years between DW and RSW workers. Occupational, personal and health records were analyzed for the 1077 workers with an initial mean age of 32.4 years (standard deviation (SD): 6.2 years), including 565 RSW workers (52%).
The initial MSCDs were 1.26 and 1.12 (p = 0.06) for DW and RSW workers, respectively; after 5 years, the increments of MSCD for DW and RSW workers were 0.10 and 0.39, respectively (p < 0.01). By performing multivariate logistic regression analyses, and comparing with DW co-workers, final results indicated that the workers exposed to RSW have 1.7-fold increased risk of elevated MSCD (95% confidence interval (CI): 1.28-2.25, p < 0.01); and are 38% less likely (adjusted rate ratio (aRR) 0.62, 95% CI: 0.45-0.86, p < 0.01) to attain decreased MSCD.
These observations demonstrate that changes of MSCD are significantly different between DW and RSW workers, and are increasingly associated with RSW exposure. In conclusion, MSCD can represent the general metabolic health conditions of a given employee group; MSC, MSCD and their transitional changes can be applied as simple and standardized tools for monitoring metabolic health risk profiles when managing employee health, at both the individual and company levels.
This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Extensive research focuses on the causes of workplace-induced stress. However, policy efforts to tackle the ever-increasing health costs and poor health outcomes in the United States have largely ignored the health effects of psychosocial workplace stressors such as high job demands, economic insecurity, and long work hours. Using meta-analysis, we summarize 228 studies assessing the effects of ten workplace stressors on four health outcomes. We find that job insecurity increases the odds of reporting poor health by about 50%, high job demands raise the odds of having a physician-diagnosed illness by 35%, and long work hours increase mortality by almost 20%. Therefore, policies designed to reduce health costs and improve health outcomes should account for the health effects of the workplace environment.
There are no consistent data on US primary care clinicians and primary care practices owing to the lack of standard methods to identify them, hampering efforts in primary care improvement.
We develop a pragmatic framework that identifies primary care clinicians and practices in the context of the US healthcare system, and applied the framework to the IQVIA OneKey Healthcare Professional database to identify and profile primary care clinicians and practices in the USA.
Our framework prescribes sequential steps to identify primary care clinicians by cross-examining clinician specialties and organizational affiliations, and then identify primary care practices based on organization types and presence of primary care clinicians. Applying this framework to the 2021 IQVIA data, we identified 365,751 physicians with a primary specialty in primary care, and after excluding those who further specialized (24%), served as hospitalists (5%), or worked in non-primary care settings (41%), we determined that 179,369 (49%) of them were actually practicing primary care. We identified 287,506 nurse practitioners and 134,083 physician assistants and determined that 88,574 (31%) and 29,781 (22%), respectively, were delivering primary care. We identified 94,489 primary care practices, and found that 45% of them were with one primary care physician, 15% had two physicians, 12% employed nurse practitioners or physician assistants only, and 19% employed both primary care physicians and specialists.
Our approach offers a pragmatic and consistent alternative to the diverse methods currently used to identify and profile primary care workforce and organizations in the USA.
Engaging the private sector in healthcare is a central theme in the work of PharmAccess Foundation, a Dutch not-for-profit organization, based in Amsterdam, with offices in several African countries, including Namibia. This thesis describes interventions developed and applied in Namibia to engage its private sector to leverage private resources for public health. Interventions and subsequent evaluations are presented according to the PharmAccess model of transitioning the vicious circle of poor healthcare in Africa into a virtuous cycle of sustainable healthcare stimulating both demand and supply, while recognizing the key stakeholders of healthcare systems as the patient, provider and payer, all functioning in a policy environment that sets the rules of interaction and exchange.
The studies presented in this thesis evaluate the PharmAccess four strategies of engaging the private sector in the public healthcare challenges in Namibia: to stimulate demand by improving health awareness of the patient; to stimulate supply by developing innovative new healthcare service provision; to innovate new payer mechanisms using subsidization; to collect and present evidence to support policy-making.
Interventions at all levels of the healthcare system are recommended. The ultimate goal is to provide the right diagnosis, at the right time, for the right patient at the right cost within the right regulatory framework, with both public and private sector contributing a complementary role. The stakeholders in the healthcare system cannot function in isolation, and this thesis demonstrates that interventions aimed at stimulating one stakeholder have an effect either directly or indirectly on the others.
The U.S. Department of Health and Human Services recommends that employers create healthy worksites through promotion wellness programs that included routine exercise, daily physical activity, and nutritional education among other initiatives.
Purpose
This study aimed to identify barriers and incentives of routine exercise in varying occupations among rural municipal workers in Southeast Georgia.
Methods
A cross-sectional research design was used to evaluate the barriers and incentives for exercise among rural municipal workers in a rural setting. The four occupational departments used for analysis were as follows: fire, police, public works, and administration/other. An electronic survey was sent to all 309 workers on November 2016. The survey asked for participants to rank 10 common exercise barriers and incentives. One-hundred and twenty-three (~40%) complete responses were used for analysis.
Results
Based on a personal ranking, lack of time to exercise (mean = 2.2), inconvenient time/location of a facility (2.5), and no motivation (5.3) were found to be the top three barriers across all employees. No significant differences ( P > 0.05) between departments were found for nine of the exercise barrier rankings. “Cost is too much” was only significantly different result found ( P = 0.019) between departments, with fire department reporting lower than the other departments. Another barrier approaching significance was “feel awkward exercising” ( P = 0.054).
Conclusions
The results suggest that a variation of motivators and incentives, depending on occupational responses, could be a successful means of improving exercise in all employees, instead of implementing a single motivating tactic based on the raw majority.
Context:
Individuals with noncommunicable diseases account for a disproportionate share of medical expenditures, absenteeism, and presenteeism. Therefore, employers are increasingly looking to worksite wellness programs as a cost-containment strategy. Previous reviews examining whether worksite wellness programs deliver a positive return on investment have shown mixed results, possibly because the more optimistic findings come from studies with poorer methodologic quality. The purpose of this systematic review is to critically revisit and update this literature to explore that hypothesis.
Evidence acquisition:
A total of 4 databases were systematically searched for studies published before June 2019. Included studies were economic evaluations of worksite wellness programs that were based in the U.S., that lasted for at least 4 weeks, and that were with at least 1 behavior change component targeting 1 of the 4 primary modifiable behaviors for chronic disease: physical activity, healthy diet, tobacco use, and harmful consumption of alcohol. Methodologic quality was assessed using Consensus for Health Economic Criteria guidelines and the risk for selection bias associated with the study design. Data extraction (September 2019-February 2020) was followed by a narrative synthesis of worksite wellness programs characteristics and return on investment estimates.
Evidence synthesis:
A total of 25 relevant studies were identified. After conducting a quality and bias assessment, only 2 of the 25 studies were found to have both high methodologic rigor and lower risk for selection bias. These studies found no evidence of a positive return on investment in the short term.
Conclusions:
The highest-quality studies do not support the hypothesis that worksite wellness programs deliver a positive return on investment within the first few years of initiation.
Objective:
Debates about the effectiveness of workplace wellness programs (WWPs) call for a review of the evidence for return on investment (ROI) of WWPs. We examined literature on the heterogeneity in methods used in the ROI of WWPs to show how this heterogeneity may affect conclusions and inferences about ROI.
Methods:
We conducted a scoping review using systematic review methods and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed PubMed, EconLit, Proquest Central, and Scopus databases for published articles. We included articles that (1) were published before December 20, 2019, when our last search was conducted, and (2) met our inclusion criteria that were based on target population, target intervention, evaluation method, and ROI as the main outcome.
Results:
We identified 47 peer-reviewed articles from the selected databases that met our inclusion criteria. We explored the effect of study characteristics on ROI estimates. Thirty-one articles had ROI measures. Studies with costs of presenteeism had the lowest ROI estimates compared with other cost combinations associated with health care and absenteeism. Studies with components of disease management produced higher ROI than programs with components of wellness. We found a positive relationship between ROI and program length and a negative relationship between ROI and conflict of interest. Evaluations in small companies (≤500 employees) were associated with lower ROI estimates than evaluations in large companies (>500 employees). Studies with lower reporting quality scores, including studies that were missing information on statistical inference, had lower ROI estimates. Higher methodologic quality was associated with lower ROI estimates.
Conclusion:
This review provides recommendations that can improve the methodologic quality of studies to validate the ROI and public health effects of WWPs.
Background: Smoking continues to be a leading cause of preventable chronic disease-related morbidity and mortality, excess healthcare expenditure, and lost work productivity. Tobacco users are disproportionately more likely to be engaging in other modifiable risk behaviours such as excess alcohol consumption, physical inactivity, and poor diet. While hundreds of interventions addressing the clustering of smoking and other modifiable risk behaviours have been conducted worldwide, there is insufficient information available about the context and mechanisms in these interventions that promote successful smoking cessation. The aim of this rapid realist review was to identify possible contexts and mechanisms used in multiple health behaviour change interventions (targeting tobacco and two or more additional risk behaviours) that are associated with improving smoking cessation outcome.
Methods: This realist review method incorporated the following steps: (1) clarifying the scope, (2) searching for relevant evidence, (3) relevance confirmation, data extraction, and quality assessment, (4) data analysis and synthesis.
Results: Of the 20,423 articles screened, 138 articles were included in this realist review. Following Michie et al.’s behavior change model (the COM-B model), capability, opportunity, and motivation were used to identify the mechanisms of behaviour change. Universally, increasing opportunities (i.e. factors that lie outside the individual that prompt the behaviour or make it possible) for participants to engage in healthy behaviours was associated with smoking cessation success. However, increasing participant’s capability or motivation to make a behaviour change was only successful within certain contexts.
Conclusion: In order to address multiple health behaviours and assist individuals in quitting smoking, public health promotion interventions need to shift away from ‘individualistic epidemiology’ and invest resources into modifying factors that are external from the individual (i.e. creating a supportive environment).
Study registration: PROSPERO registration number: CRD42017064430
Numerous recent studies have documented the importance of cardiorespiratory fitness (CRF) in the risk paradigm among subjects both with and without chronic disease. In fact, in many recent studies, CRF has been shown to be a more powerful risk marker than the traditional risk factors for cardiovascular disease. These observations have been an impetus to include fitness as one of the primary “vital signs” along with the traditional risk markers that include hypertension, lipid abnormalities, smoking, obesity, and diabetes. These studies have also led to increasing efforts to promote physical activity through employer-based worksite wellness programs, which have been consistently shown to have a positive economic impact. However, less is known regarding the association between objective measures of CRF and healthcare costs. In recent years, a limited number of studies have provided insight into this issue. Although quantifying healthcare costs is challenging, these studies are consistent in the demonstration that higher CRF is associated with lower healthcare costs. A small increment in CRF appears to have a major impact on costs; each 1-MET higher CRF level is associated with 5–7% reductions in healthcare costs. These studies are also consistent when adjusted for potentially confounding factors, are not altered appreciably by including or excluding patients with cardiovascular disease, and appear to be more pronounced among overweight and obese subjects, and CRF appears to be a powerful predictor of healthcare costs. Thus, efforts to improve CRF not only have a favorable impact on health outcomes, but they also result in lower healthcare costs. The purpose of this chapter is to review the available literature addressing the association between CRF and healthcare costs.
Organizations often fail to establish a clear awareness of what employees consider fair when implementing changes to employee benefits in the workplace. In 2016, the Johns Hopkins Health System (JHHS) enhanced their tobacco control efforts. In addition to enhanced smoking cessation benefits, employees were offered an increased reduction in their insurance premiums if they were nonsmokers. To qualify for the reduction, employees participated in testing rather than relying on self-reporting as had been done in the past. The shift to testing prompted a concern by some senior management at JHHS who did not want employees to feel they were not trusted. As the program unfolded at JHHS, the four-component model of procedural justice was applied to provide a framework for reviewing the implementation of the new voluntary tobacco testing at JHHS from a fairness lens. The purpose of this article is to illustrate the application of the four-component procedural model of justice to the tobacco testing process at JHHS. As approximately 75% of employees participated in the program, the experience at JHHS can be instructive to other employers who are looking to implement changes in their workplaces and how to minimize unintended consequences with their employees.
Background. Lifestyle medicine has emerged as a transformational force in mainstream health care. Numerous health promotion and wellness programs have been created to facilitate the adoption of increased positive, modifiable health behaviors to prevent and lessen the effects of chronic disease. This article provides a scoping review of available health promotion interventions that focus on healthy adult populations in the past 10 years. Methods. We conducted a scoping review of the literature searching for health promotion interventions in the past 10 years. Interventions were limited to those conducted among healthy adults that offered a face-to-face, group-based format, with positive results on one or more health outcomes. We then developed a new health promotion intervention that draws on multiple components of included interventions. Results. Fifty-eight articles met our inclusion criteria. Physical activity was the primary focus of a majority (N = 47) of articles, followed by diet/nutrition (N = 40) and coping/social support (N = 40). Conclusions. Efficacious health promotion interventions are critical to address the prevention of chronic disease by addressing modifiable risk factors such as exercise, nutrition, stress, and coping. A new intervention, discussed is this article, provides a comprehensive approaches to health behavior change and may be adapted for future research.
Purpose
To examine the effects of an employer-based monetary incentive program on membership termination and usage at a fitness center.
Design
Retrospective nested case–control study examining the relationship between participation in an incentive program, visits to the fitness center, and membership termination at 1 year.
Setting
University-based fitness center.
Participants
Members (N = 1122) of a university-based fitness center.
Intervention
Members were offered either a US$25 incentive for each month they visited the fitness center at least 10 times or no incentive.
Measures
Data were extracted from the membership database and included membership termination at 1 year (yes, no), length of membership (days), participation in the incentive program (yes, no), and visits to the fitness center per month.
Analysis
Cox proportional hazards model.
Results
Members in the incentive program visited the fitness center on average more times per month (5.3 vs 4.3; P < .0001) but were significantly more likely to terminate memberships at 1 year compared to members who did not receive the incentive (38% vs 31%; P = .013). After controlling for relevant covariates, members who received the incentive had a 24% greater hazard of terminating their memberships compared to members who did not receive the incentive (hazard ratio [HR] = 1.24; P = .041). After controlling for the number of visits per month, the incentive program was no longer significantly related to membership termination (HR = 1.21; P = .07).
Conclusion
Being in a monetary incentive program to attend a fitness center may be initially associated with a greater fitness center utilization but may not be associated with a reduced risk of membership termination.
Non-communicable diseases, such as cardiovascular disease (CVD), obesity, cancer, pulmonary disease, and diabetes is a very high global health concern. The health costs of risk factors for CVD, such as hypertension (HTN), is mounting and are unrelenting. As an example, it is estimated that direct and indirect costs due to HTN amounted to $46.4 billion in 2011 and projections of six-fold increases by 2030, the importance of low-cost nonpharmacological interventions involving collaborative teams of health care professionals is at a critical junction. Certainly, the data supported by research including some clinical trials for healthy living interventions support deploying health education, nutrition, smoking cessation, and physical activity(PA) in preventing CVD risk, such as HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of BP management. However, less is known about what optimization of PA/ET modalities with nutrition and lifestyle tracking with modern era technologies will bring to this equation. New research methods may need to consider how to collaborate to collect data in using teams of researchers while interacting with community centers, school systems, and in traditional health care practices. This review will discuss and present what is known about the research that support modern era healthy living medicine and how this data may be integrated in venues that support health lifestyle in the community (i.e. schools and the work place).
Non-communicable diseases (NCDs) are five of the top ten causes of death for Americans: cardiovascular disease (CVD), cancer, lower respiratory disease, stroke and diabetes mellitus. Risk factors for these NCDs and for CVD are tobacco use, poor diet quality, physical inactivity, increase body mass index, increased blood pressure, increased blood cholesterol, and glucose intolerance. Depression, depressive symptoms and anxiety also contribute to CVD risk. There is also evidence work stress itself contributes to CVD risk. By 2024 there is expected to be approximately 164 million workers in the US labor force and the share of older workers will likewise increase. Currently, about 25 million of those are over the age of 55, the age at which many diseases of lifestyle become clinically apparent. Furthermore, Americans spend as much as half of their waking hours at work. This makes the worksite an important target for the delivery of healthy living medicine.
Background:
Worksite wellness programs offer an ideal setting to target high-risk sedentary workers to improve health status. Lack of physical activity is associated with increased risk for coronary heart disease and mortality. Despite the risks, the number of sedentary workers is increasing.
Objective:
This study examined the perceived barriers and motivators for physical activity among employees at high-risk for coronary heart disease.
Methods:
A purposive sample of 24 high-risk workers participating in a wellness program in rural South Carolina were enrolled in the study. Qualitative data was obtained through semi-structured face-to-face interviews. Grounded theory was used to analyze qualitative data, and identify overarching themes.
Results:
Physical limitations due to pain and weakness, lack of motivation, and lack of time emerged as the main barriers to physical activity. Family relationships were reported as the strongest motivator along with social support and potential health benefits.
Conclusion:
Findings highlight the unique experience of high-risk workers with physical activity. The findingsunderscore the need to design and implement effective interventions specifically designed to meet the needs of high-risk employees.
Purpose: The purposes of this study were to review the research trends and to identify developmental direction of studies on community interventions according to the ecological model for workers with cardiovascular diseases (CVD) risk factors. Methods: Electronic databases including PsycINFO, PubMed, EMBASE, CINAHL, and Cochrane Library and the reference lists of articles were searched. All articles were assessed in relation to inclusion and exclusion criteria, resulting in 29 researches being reviewed. Each review was critically appraised by two authors using a guideline of PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses). Results: Nowadays, interventions in organizational level, integrated and web-based interventions are increasing to prevent CVD risk factors for workers. Even though the importance of psychosocial aspects to prevent CVD, the only 2 studies included psychosocial factors in the outcome variables. Also, 14% among 29 researches were based on theories. Conclusion: Psychosocial factors such as job stress, depression, and emotional labor could be CVD risk factors. Therefore, interventions including psychosocial aspects are needed to prevent workers` CVD risks more effectively. Theory-based interventions are needed to support interventions` effects and to develop the nursing science.
Regular physical activity is strongly linked to prevention of costly chronic health conditions. However, there has been limited examination of the impact that level of participation in physical activity promotion programs has on health care costs. This study examined a fitness reimbursement program (FRP) offered to small employers. FRP participants received 6.14 (2.6%) for low-moderate (P = 0.60), 20.01 (8.4%) for high (P = 0.08). With high-cost outliers included, significant monthly cost savings were observed for the moderate-high (52.66, P < 0.001) cohorts. These results indicate directionally positive cost outcomes associated with increasing level of fitness center participation. (Population Health Management 2015;xx:xxx-xxx).
Exercise delays aging and is a powerful tool for prevention, care and rehabilitation of chronic diseases. Life stile interventions, based on nutrition and physical activity, improve general population quality of life and induce great reduction in medical and social costs. Exercise health benefits on chronic diseases main risk factors (obesity, hypertension, diabetes, dyslipemia, metabolic syndrome, smoking, cancer) and how they work are revised. Necessity of accurate exercise prescription (mode, intensity, duration, frequency, energetic cost) is stressed.
Public service transformation has been at the heart of government since 1994. Therefore, to ensure that transformation takes place at different government departments, a number of programmes were introduced. One of such programmes is Employee Health and Wellness programme. The main focus of this programme is to bring about changes in the wellbeing and the working environment in the departments so that service delivery, employees’ health and productivity can be accelerated and improved. Thus, the Limpopo Department of Agriculture started the implementation of an Employee Health and Wellness program in 2001 in response to the government mandate which was brought about by the birth of new democracy. Since every important programme has to be evaluated, therefore this article reports on the evaluation that was conducted on the success of wellness programmes in combating absenteeism in the Limpopo Department of Agriculture. Absenteeism in most government departments is a serious problem that negatively affects the delivery of services. There are many cases of absenteeism which have varied causes. However, the focus of this article is on the effectiveness of wellness management programme on combating absenteeism, and addressing the challenges of absenteeism due to substance abuse in the public service. The findings indicated that absenteeism negatively affects service delivery in the public sector and that participants on these programmes are offered limited support by their supervisors. Supervisors tend to show negative tendencies towards the wellness management participants who show little progress in recovery. This article therefore recommends that wellness programmes have to be fully supported by the management of various organizations so that they can be successful. Departments should also develop strategies that can curb substance abuse amongst the employees.
DOI: 10.5901/mjss.2014.v5n27p1286
Background:
Poor medication adherence is associated with worsened health outcomes and higher health care expenditures. An increasing number of employers are sponsoring wellness initiatives designed to support healthy lifestyles, improve productivity, and offer a return on investment. Onsite pharmacies may facilitate higher medication adherence rates by providing employees a convenient, low-cost option for filling prescriptions that is integrated with other onsite health services.
Objectives:
To (a) assess the impact of an employer's onsite pharmacy on health plan members' medication adherence using multiple measures of medication adherence and persistence, including medication possession ratio (MPR), average number of days until discontinuation (60-day gap in coverage), and percentage of members without a 30-day gap in coverage, and (b) evaluate these outcomes between those members who participated in condition management programs and those who did not.
Methods:
A retrospective analysis of a self-insured employer's claims data was undertaken. Medication adherence was assessed among the self-insured employer's health plan members, which included subscribers and their dependents who filled an asthma, depression, diabetes, hypertension, or hyperlipidemia medication at an onsite pharmacy, compared with those who used a community pharmacy. Multiple standard measures of medication adherence were considered. These measures included MPR, which was assessed for 1- and 2-year time periods. MPR was chosen because it is one of the most commonly referenced formulas in the literature and represents adherence over a fixed period of time. In addition, medication persistence was estimated by 30-day gaps in coverage and discontinuation of treatment. To assess the impact of onsite pharmacy use and account for covariate effects, the linear mixed model approach was applied with the logit transformed MPR as the response variable. An analysis of MPR among condition management participants was also performed.
Results:
In total, 2,498 subscribers and their dependents were included in the analysis. The average MPR at 365 days was significantly higher (P less than 0.0001) among onsite pharmacy users for all medication types, ranging from 13% higher for depression medications to 20% higher for hypertension medications. This trend persisted at 730 days (P less than 0.001), with average MPRs ranging from 6% higher for hyperlipidemia medications to 11% higher for hypertension medications. A mixed model analysis indicated that members who used the onsite pharmacy were 3.44 times more likely to demonstrate medication adherence (95% CI = 2.84-4.16; P less than 0.0001) at 365 days. Likewise, at 180 and 365 days, onsite pharmacy users were less likely to have 30-day gaps in treatment. The average number of days until discontinuation (defined as a 60-day gap) was also significantly longer (P less than 0.0001) among onsite pharmacy users, ranging from an average of 56 additional days for depression medications to 105 additional days for hypertension medications. While the average MPR tended to be higher among those subscribers and their dependents who participated in condition management programs, this trend was not statistically significant for all medication types.
Conclusions:
Based on multiple measures, onsite pharmacy use was associated with higher medication adherence, while the results were inconclusive for condition management participation.
Healthcare organizations and their employees are critical role models for healthy living in their communities. The American Heart Association (AHA) 2020 impact goal provides a national framework that can be used to track the success of employee wellness programs with a focus on improving cardiovascular (CV) health. This study aimed to assess the CV health of the employees of Baptist Health South Florida (BHSF), a large nonprofit healthcare organization.
HRAs and wellness examinations can be used to measure the cardiovascular health status of an employee population.
The AHA's 7 CV health metrics (diet, physical activity, smoking, body mass index, blood pressure, total cholesterol, and blood glucose) categorized as ideal, intermediate, or poor were estimated among employees of BHSF participating voluntarily in an annual health risk assessment (HRA) and wellness fair. Age and gender differences were analyzed using χ(2) test.
The sample consisted of 9364 employees who participated in the 2014 annual HRA and wellness fair (mean age [standard deviation], 43 [12] years, 74% women). Sixty (1%) individuals met the AHA's definition of ideal CV health. Women were more likely than men to meet the ideal criteria for more than 5 CV health metrics. The proportion of participants meeting the ideal criteria for more than 5 CV health metrics decreased with age.
A combination of HRAs and wellness examinations can provide useful insights into the cardiovascular health status of an employee population. Future tracking of the CV health metrics will provide critical feedback on the impact of system wide wellness efforts as well as identifying proactive programs to assist in making substantial progress toward the AHA 2020 Impact Goal.
© 2015 Wiley Periodicals, Inc.
Enhancing daily functioning and well-being is an increasingly advocated goal in the treatment of patients with chronic conditions. We evaluated the functioning and well-being of 9385 adults at the time of office visits to 362 physicians in three US cities, using brief surveys completed by both patients and physicians. For eight of nine common chronic medical conditions, patients with the condition showed markedly worse physical, role, and social functioning; mental health; health perceptions; and/or bodily pain compared with patients with no chronic conditions. Each condition had a unique profile among the various health components. Hypertension had the least overall impact; heart disease and patient-reported gastrointestinal disorders had the greatest impact. Patients with multiple conditions showed greater decrements in functioning and well-being than those with only one condition. Substantial variations in functioning and well-being within each chronic condition group remain to be explained.
Medical claims cost distributions and factors that relate to these costs were studied among 7796 employees who selected an indemnity medical plan for at least one year during 1985 to 1990. Descriptions for medical claims costs were presented for both single- and multiple-year time periods. Factors that associated with high cost status were studied by using multiple logistic regression models. Employees at or above the top tenth cost percentile were accounted for approximately 80%, 65%, and 58% of the total employees' medical costs to the employer in single-year, 3-year, and 6-year periods, respectively. Bivariate analyses indicated tht six of the seven selected demographic variables were significantly related to cost status. When the multivariate models excluded health risk measures, four of the demographic variables and the frequency of health risk appraisal completion were significantly associated with cost status. When the multivariate models included health risk measures, the health risk measures became the dominant predictors of the high-cost status.
We forecast a slowdown in national health spending growth in 2002 and 2003, reflecting slower projected Medicare and private personal health spending growth. These factors outweigh higher projected Medicaid spending growth, caused by weak labor markets, and an expectation of continued high private health insurance premium inflation related to the underwriting cycle. Over the entire projection period, national health spending growth is still expected to outpace economic growth. The result is that the health share of gross domestic product is projected to increase from 14.1 percent in 2001 to 17.7 percent in 2012.
This study examines how wellness scores generated from the Health Risk Appraisal are associated with prospective medical claims costs, controlling for age, gender, and disease status. The study was conducted among 19,861 active employees who participated in the Health Risk Appraisal and selected indemnity or PPO medical plans from 1996 to 1998. A multiple regression model based on group averages of age, gender, disease status, and wellness score levels was developed among a randomly selected screening subsample (n=10,172) from the study sample. Total medical claim costs of -56, 88, and $3574 were estimated for one additional point on the wellness score, 1 year of additional age, and an existing major disease, respectively. No significant differences were found between the model predicted and actual medical claims costs for the individuals in both screening and calibration (n=9689) subsamples.
Evidence about the total cost of health, absence, short-term disability, and productivity losses was synthesized for 10 health conditions. Cost estimates from a large medical/absence database were combined with findings from several published productivity surveys. Ranges of condition prevalence and associated absenteeism and presenteeism (on-the-job-productivity) losses were used to estimate condition-related costs. Based on average impairment and prevalence estimates, the overall economic burden of illness was highest for hypertension (368), depression and other mental illnesses (327). Presenteeism costs were higher than medical costs in most cases, and represented 18% to 60% of all costs for the 10 conditions. Caution is advised when interpreting any particular source of data, and the need for standardization in future research is noted.
The objective of this study was to examine the health risk-related excess costs of time away from work, medical claims, pharmacy claims, and total costs with and without considering the prevalence of health risks.
A total of 2082 of 4266 employees of a Midwest utility participated in a health risk appraisal (HRA). Individuals were classified by their HRA participation status and also by 15 health risks. Total and excess costs were analyzed for all employees.
There were significant excess costs due to individual risks and overall excess health risks in all cost measures. Both excess cost per risk and prevalence of the risk were important factors in determining the excess costs in the population. As compared with low-risk participants, HRA nonparticipants and the medium- and high-risk participants were 1.99, 2.22, and 3.97 times more likely to be high cost status.
Approximately one third of corporate costs in medical claims, pharmacy claims, and time away from work could be defined as excess costs associated with excess health risks.
Purpose. To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. Design. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. Setting. The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. Subjects. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. Measures. Eleven risk factors (exercise, alcohol use, eating current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. Results. Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. Conclusions. Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.
Four clinical interview questions, the CAGE questions, have proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The acronym "CAGE" helps the physician to recall the questions.How these questions were identified and their use in clinical and research studies are described.(JAMA 1984;252:1905-1907)
Low levels of high-density lipoprotein cholesterol (HDL-C) represent a major cardiovascular risk factor, with a stronger relationship to coronary heart disease than that seen with elevated levels of low-density lipoprotein cholesterol (LDL-C). HDL-C has important antiatherogenic effects, including reverse cholesterol transport, inhibition of LDL-C oxidation, and antiplatelet and anti-inflammatory actions. Patients with low HDL-C are also at an amplified risk of coronary heart disease due to the common coexistence of other risk factors, including excess adiposity, metabolic syndrome, type 2 diabetes mellitus, hypertriglyceridemia, and the atherogenic dyslipidemia characterized by small dense LDL-C. First-line therapy of low HDL-C generally consists of nonpharmacologic measures such as improved fitness and weight loss. Current pharmaceutical options include statins, fibrates, and nicotinic acid. A host of novel approaches involving HDL-C and reverse cholesterol transport hold the promise of fundamentally changing the natural history of atherosclerosis, the most common and important chronic disease in humans.
Of 22 randomized trials of rehabilitation with exercise after myocardial infarction (MI), one trial had results that achieved conventional statistical significance. To determine whether or not these studies, in the aggregate, show a significant benefit of rehabilitation after myocardial infarction, we performed an overview of all randomized trials, involving 4,554 patients; we evaluated total and cardiovascular mortality, sudden death, and fatal and nonfatal reinfarction. For each endpoint, we calculated an odds ratio (OR) and 95% confidence interval (95% CI) for the trials combined. After an average of 3 years of follow-up, the ORs were significantly lower in the rehabilitation than in the comparison group: specifically, total mortality (OR = 0.80 [0.66, 0.96]), cardiovascular mortality (OR = 0.78 [0.63, 0.96]), and fatal reinfarction (OR = 0.75 [0.59, 0.95]). The OR for sudden death was significantly lower in the rehabilitation than in the comparison group at 1 year (OR = 0.63 [0.41, 0.97]). The data were compatible with a benefit at 2 (OR = 0.76 [0.54, 1.06]) and 3 years (OR = 0.92 [0.69, 1.23]), but these findings were not statistically significant. For nonfatal reinfarction, there were no significant differences between the two groups after 1 (OR = 1.09 [0.76, 1.57]), 2 (OR = 1.10 [0.82, 1.47]), or 3 years (OR = 1.09 [0.88, 1.34]) of follow-up. The observed 20% reduction in overall mortality reflects a decreased risk of cardiovascular mortality and fatal reinfarction throughout at least 3 years and a reduction in sudden death during the 1st year after infarction and possibly for 2-3 years. With respect to the independent effects of the physical exercise component of cardiac rehabilitation, the relatively small number of "exercise only" trials, combined with the possibility that they may have had a formal or informal nonexercise component precludes the possibility of reaching any definitive conclusion. To do so would require a randomized trial of sufficient size to distinguish between no effect and the most plausible effect based on the results of this overview.
The Symptom Questionnaire (SQ) is a yes/no questionnaire with brief and simple items. It contains state scales of depression, anxiety, anger-hostility, and somatic symptoms. It was developed from earlier versions to make the scales more sensitive for clinical research. The scales have been extensively validated. The psychometric properties of the SQ are somewhat different from those of similar scales. In double-blind, crossover studies, they tended to be more sensitive than other scales in discriminating between the effects of a psychotropic drug and placebo and were found to be highly sensitive in discriminating between distress levels of groups. In studies with small or moderately sized samples in which the sensitivity of scales is important or in populations that include subjects with poor verbal skills, the SQ seems to have advantages. The SQ is suitable for the measurement of distress and hostility in research and as a checklist in clinical work.
Four clinical interview questions, the CAGE questions, have proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The acronym "CAGE" helps the physician to recall the questions. How these questions were identified and their use in clinical and research studies are described.
AS THE national debate about our health care system intensifies, it is timely to raise some important issues that should be seriously considered. I refer to the need for more preventive medicine, which should be part of the national debate, but with other basic problems may be passed over in the haste to deal just with cost issues. My aim is not to review the potential health benefits of preventive medicine but to indicate how health promotion should be an essential ingredient combined with curative medicine to create a comprehensive health care system. Although preventive medicine is not solely the domain of physicians, physicians should lead its practice. Preventive cardiology will be considered because heart disease continues to be the leading cause of premature death in our society, because the current practice of cardiology is a major item in our health costs, and because much is known about how to
This investigation estimates the impact of ten modifiable health risk behaviors and measures and their impact on health care expenditures, controlling for other measured risk and demographic factors. Retrospective two-stage multivariate analyses, including logistic and linear regression models, were used to follow up 46,026 employees from six large health care purchasers for up to 3 years after they completed an initial health risk appraisal. These participants contributed 113,963 person-years of experience. Results show that employees at high risk for poor health outcomes had significantly higher expenditures than did subjects at lower risk in seven of ten risk categories: those who reported themselves as depressed (70% higher expenditures), at high stress (46%), with high blood glucose levels (35%), at extremely high or low body weight (21%), former (20%) and current (14%) tobacco users, with high blood pressure (12%), and with sedentary lifestyle (10%). These same risk factors were found to be associated with a higher likelihood of having extremely high (outlier) expenditures. Employees with multiple risk profiles for specific disease outcomes had higher expenditures than did those without these profiles for the following diseases: heart disease (228% higher expenditures), psychosocial problems (147%), and stroke (85%). Compared with prior studies, the results provide more precise estimates of the incremental medical expenditures associated with common modifiable risk factors after we controlled for multiple risk conditions and demographic confounders. The authors conclude that common modifiable health risks are associated with short-term increases in the likelihood of incurring health expenditures and in the magnitude of those expenditures.
To determine the effects of cardiac rehabilitation interventions on patients with hostility, or unexpressed anger, a coronary heart disease risk factor that adversely affects morbidity and mortality after major coronary heart disease events.
Using validated questionnaires to evaluate behavioral characteristics and quality of life, we studied 500 consecutive patients before and after cardiac rehabilitation and compared a group of 65 patients with high levels of hostility with 435 patients with low levels of hostility.
After rehabilitation, statistically significant improvements occurred in the total cohort in scores for anxiety, depression, and somatization, as well as total quality of life, but not in hostility score (-20%; P = .07). Patients with high levels of hostility had significant improvements in hostility scores as well as other behavioral characteristics (anxiety, depression, and somatization) and all quality-of-life components. These patients also improved exercise capacity, percent body fat, body mass index, and total cholesterol and high-density lipoprotein cholesterol levels. Compared with patients with low levels of hostility, those with high levels of hostility had greater relative improvements in hostility scores, as well as anxiety, general health, energy, mental health, and total quality-of-life scores, and had similar improvements in exercise capacity, obesity indexes, lipid levels, and other behavioral characteristics and quality-of-life measurements. After cardiac rehabilitation, the prevalence of high levels of hostility decreased by 40%, from 13% to 8% (P < .01).
These data suggest that cardiac rehabilitation reduces hostility and significantly improves quality of life and other behavioral characteristics in patients with high levels of hostility. We believe that greater attention should be directed at behavioral characteristics, including hostility, to enhance the primary and particularly the secondary prevention of coronary heart disease.
The prevalence of the metabolic syndrome (MS) and the effects of formal phase II cardiac rehabilitation and exercise training program have not been assessed in patients with coronary artery disease (CAD). The present study examines the prevalence of MS in patients with CAD after major coronary events and assesses the salutary effects of a rigorous program to produce therapeutic lifestyle change in these patients. We reviewed the case records of 235 consecutive patients with CAD who completed a 3-month formal program of cardiac rehabilitation and exercise training to ascertain relevant anthropometric, lipid, and clinical data. Detailed program components have been reviewed elsewhere, 1–3 but in brief, patients received individual and group counseling from a registered dietitian in dietary management as recommended by recent national guidelines. 4 Patients received formalized exercise instruction, met 3 times per week for group exercise classes, and were encouraged to exercise on their own (1 to 3 times per week) in between sessions. Patients’ exercise recommendations were tailored toward the anaerobic threshold achieved during entry testing. Specific weight management guidance was given to those subjects identified as overweight and obese. Educational classes were given with regard to all aspects of CAD risk, including hypertension, smoking cessation, and diabetes management. In all patients, fasting lipids, glucose, high-sensitivity C-reactive protein (hs-CRP), percent body fat, abdominal girth, and blood pressure at rest were obtained at entry and at completion of the formal program. Most subjects entered the program 3 to 5 weeks (mean 3.3 3.4) after hospital discharge. Percentage of body fat was determined by the skinfold technique, using the average of 3 skinfolds (thigh, chest, and abdomen in men; thigh, triceps, and suprailium in women). 5,6 All measurements were made in the early morning before exercise. A group of 42 subjects who planned to enter the rehabilitation program during the same time period and had their baseline laboratory work, but who dropped out before beginning active participation in the program, agreed to serve as a control group; these subjects had additional laboratory work free of charge for the purpose of monitoring risk factors over time. All subjects were initially evaluated 3 to 6 weeks after hospital discharge, and repeat measurements of these parameters were performed between 3 and 6 months after initial testing. The principal reasons for not participating in the program were financial (55%) and traveling distance to the rehabilitation facility (33%). Seventy-nine percent of the control subjects underwent percutaneous coronary intervention, 21% had coronary bypass, and 24% had myocardial infarction; the study cohort had similar percentages. Patients and control subjects who were taking either lipid-lowering medication (including statins: 65% of rehabilitation patients, 59% of control subjects) or hormone replacement therapy remained on constant doses for a period of 6 weeks before the initial assessment and throughout the evaluation period. The presence of MS was determined using the definition set forth by recent national gudelines. 4 Spe
Numerous studies have indicated that psychological distress, including anxiety, is a significant risk factor for coronary artery disease (CAD). We studied 500 consecutive patients after recent CAD events and demonstrated a very high prevalence of generalized anxiety and moderate to severe anxiety symptoms, particularly in younger patients. In addition, our data demonstrate the abnormal CAD risk profiles in these anxious patients with CAD and the marked improvements in the overall risk profiles, levels of anxiety, and overall quality of life after cardiac rehabilitation and exercise training programs. Greater attention at detecting and treating chronic anxiety, particularly with formal cardiac rehabilitation, is needed for the secondary prevention of CAD.
This study was designed to assess the effects of three-month formal phase II cardiac rehabilitation and exercise training programs on high-sensitivity C-reactive protein (HSCRP) levels in patients with coronary heart disease (CHD).
High-sensitivity C-reactive protein is associated with abdominal adiposity and other CHD risk factors and is a potent independent predictor of CHD events. Although weight reduction and statin therapy reduce HSCRP levels, the independent effects of cardiac rehabilitation programs on HSCRP are not well established.
We analyzed plasma levels of HSCRP in 277 patients with CHD (235 consecutive patients before and after formal phase II cardiac rehabilitation and exercise training programs and 42 "control" patients who did not attend cardiac rehabilitation). Additionally, we determined the effects of cardiac rehabilitation on HSCRP independent of statin therapy and weight loss.
Rehabilitation patients improved significantly in body fat, obesity indices, exercise capacity, and other cardiac risk factors. Mean (5.9 +/- 7.7 to 3.8 +/- 5.8 mg/l; -36%; p < 0.0001) and median levels of HSCRP (-41%; p = 0.002) decreased significantly in the rehabilitation group but not in the control population. Similar significant reductions in HSCRP occurred in the rehabilitation patients regardless of whether they received statin therapy or lost weight.
Therapeutic lifestyle changes effected through a three-month cardiac rehabilitation program significantly improved numerous cardiac risk factors. Through this holistic approach to secondary prevention, we observed significant reductions in HSCRP levels. These findings identify another clinical modality of reducing HSCRP beyond use of statin drugs and suggest an additional benefit of formal phase II cardiac rehabilitation and exercise training programs.
Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown.
We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here. Odds ratios and their 99% CIs for the association of risk factors to myocardial infarction and their population attributable risks (PAR) were calculated.
Smoking (odds ratio 2.87 for current vs never, PAR 35.7% for current and former vs never), raised ApoB/ApoA1 ratio (3.25 for top vs lowest quintile, PAR 49.2% for top four quintiles vs lowest quintile), history of hypertension (1.91, PAR 17.9%), diabetes (2.37, PAR 9.9%), abdominal obesity (1.12 for top vs lowest tertile and 1.62 for middle vs lowest tertile, PAR 20.1% for top two tertiles vs lowest tertile), psychosocial factors (2.67, PAR 32.5%), daily consumption of fruits and vegetables (0.70, PAR 13.7% for lack of daily consumption), regular alcohol consumption (0.91, PAR 6.7%), and regular physical activity (0.86, PAR 12.2%), were all significantly related to acute myocardial infarction (p<0.0001 for all risk factors and p=0.03 for alcohol). These associations were noted in men and women, old and young, and in all regions of the world. Collectively, these nine risk factors accounted for 90% of the PAR in men and 94% in women.
Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions. This finding suggests that approaches to prevention can be based on similar principles worldwide and have the potential to prevent most premature cases of myocardial infarction.
This article updates the 1994 American Heart Association scientific statement on cardiac rehabilitation. It provides a review of recommended components for an effective cardiac rehabilitation/secondary prevention program, alternative ways to deliver these services, recommended future research directions, and the rationale for each component of the rehabilitation/secondary prevention program, with emphasis on the exercise training component.
To determine the prevalence of hostility symptoms in young patients with coronary artery disease (CAD), the associated risk factor profile in these patients, and the effects of a formal phase 2 cardiac rehabilitation and exercise training program.
Our study included consecutive CAD patients referred for cardiac rehabilitation from May 1999 through December 2000. At baseline and after rehabilitation, behavioral factors and quality of life were assessed by validated questionnaires, and standard CAD risk factors were measured, including exercise capacity. We specifically evaluated detailed data for young patients.
A total of 500 patients were included in the study. Hostility scores were 2.5 times higher (P<.001) in the 81 young patients (< 50 years; mean +/- SD age, 45 +/- 5 years) than in the 268 elderly patients (> or = 65 years; mean +/- SD age, 70 +/- 4 years), and the prevalence of hostility symptoms was 3.5 times higher in young patients (28% vs 8%; P<.001). Young patients with hostility symptoms also had more adverse CAD risk profiles, including higher total cholesterol levels, triglyceride levels, total cholesterol/high-density lipoprotein cholesterol ratios, fasting glucose levels, and glycosylated hemoglobin levels and lower quality-of-life scores compared with young patients with low hostility scores. After cardiac rehabilitation, young patients with hostility symptoms had marked improvements in CAD risk factors, behavioral characteristics (including hostility), and quality of life, and a nearly 50% (P=.005) reduction in the prevalence of hostility symptoms occurred.
Young CAD patients have a high prevalence of hostility symptoms and adverse CAD risk profiles. Reducing hostility symptoms and other parameters of psychological distress in young CAD patients should be emphasized, and the potential benefits of cardiac rehabilitation programs in the secondary prevention of CAD should be highlighted.
Chronic disease affects 90 million American adults and disproportionately affects the elderly. Health literacy, or the ability to understand and apply information to care for oneself, is a challenge for the approximately 1 in 2 American adults who cannot read above a fifth-grade level. This article defines the problem of health literacy and provides useful information for case managers to better understand the scope of the problem and strategies for working with patients to ensure good communication.
All settings.
Raising awareness of the scope of low literacy among patients is critical for any practice. Implementing basic practices to ensure effective communication will increase the likelihood of patient compliance and successful outcomes.
Keep key messages to patients to a minimum. Use the teach-back method with patients to ensure that they understand their care regimen and warning signs. Never ask, " Do you understand?" Ask patients to explain processes. Have your written patient education materials reviewed by a literacy expert to determine grade reading level. Materials should not be above a fifth-grade level, and should be culturally appropriate.
Depression following major cardiac events is associated with higher mortality, but little is known about whether this can be reduced through treatment including cardiac rehabilitation and exercise training. We evaluated the impact of cardiac rehabilitation on depression and its associated mortality in coronary patients.
We evaluated 522 consecutive coronary patients (381 men, 141 women; aged 64+/-10 years) enrolled in cardiac rehabilitation from January 2000 to July 2005 and a control group of 179 patients not completing rehabilitation. Depressive symptoms were assessed by questionnaire at baseline and following rehabilitation, and mortality was evaluated after a mean follow-up of 1296+/-551 days.
Prevalence of depressive symptoms decreased 63% following rehabilitation, from 17% to 6% (P <.0001). Depressed patients following rehabilitation had an over 4-fold higher mortality than nondepressed patients (22% vs 5%, P=.0004). Depressed patients who completed rehabilitation had a 73% lower mortality (8% vs 30%; P=.0005) compared with control depressed subjects who did not complete rehabilitation. Reductions in depressive symptoms and its associated mortality were related to improvements in fitness; however, similar reductions were noted in those with either modest or marked increases in exercise capacity.
In patients following major coronary events, cardiac rehabilitation is associated with both reductions in depressive symptoms and the excess mortality associated with it. Moreover, only mild improvements in levels of fitness appear to be needed to produce these benefits on depressive symptoms and its associated mortality.
An extensive body of data shows concordant J-shaped associations between alcohol intake and a variety of adverse health outcomes, including coronary heart disease, diabetes, hypertension, congestive heart failure, stroke, dementia, Raynaud's phenomenon, and all-cause mortality. Light to moderate alcohol consumption (up to 1 drink daily for women and 1 or 2 drinks daily for men) is associated with cardioprotective benefits, whereas increasingly excessive consumption results in proportional worsening of outcomes. Alcohol consumption confers cardiovascular protection predominately through improvements in insulin sensitivity and high-density lipoprotein cholesterol. The ethanol itself, rather than specific components of various alcoholic beverages, appears to be the major factor in conferring health benefits. Low-dose daily alcohol is associated with better health than less frequent consumption. Binge drinking, even among otherwise light drinkers, increases cardiovascular events and mortality. Alcohol should not be universally prescribed for health enhancement to nondrinking individuals owing to the lack of randomized outcome data and the potential for problem drinking.
We examined worksite health promotion programs, policies, and services to monitor the achievement of the Healthy People 2010 worksite-related goal of 75% of worksites offering a comprehensive worksite health promotion program.
We conducted a nationally representative, cross-sectional telephone survey of worksite health promotion programs stratified by worksite size and industry type. Techniques appropriate for analyzing complex surveys were used to compute point estimates, confidence intervals, and multivariate statistics.
Worksites with more than 750 employees consistently offered more programs, policies, and services than did smaller worksites. Only 6.9% of responding worksites offered a comprehensive worksite health promotion program. Sites with a staff person dedicated to and responsible for health promotion were significantly more likely to offer a comprehensive program, and sites in the agriculture and mining or financial services sector were significantly less likely than those in other industry sectors to offer such a program.
Increasing the number, quality, and types of health promotion programs at worksites, especially smaller worksites, remains an important public health goal.
National Business Group on Health. An Employer's Guide to Behavioral Health Services. A Roadmap and Recommendations for Evaluating, Designing and Im-plementing Behavioral Health Services
- Center
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Position Statement on Effective Worksite Wellness Programs Available at
Position Statement on Effective Worksite Wellness Programs. American
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Detecting alcoholism
- Ewing