Worksite health programs improve blood pressure and diabetes control

May 11 2007

Employees who participated in a worksite health program improved blood pressure control by 9 percent and diabetes control by 15 percent, researchers reported at the American Heart Association's 8th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

During three years (2004-06) of follow-up on 2,100 workers, researchers also found that absenteeism declined significantly at JEA, a municipal utility in Jacksonville, Fla. The number of employees who missed work due to hypertension dropped from 25.8 percent to 15.6 percent, while those who missed work because of diabetes dropped by 66.2 percent (from 50 percent to 16.9 percent).

Workplace accidents also dropped by nearly 70 percent from 83 incidents in 2003 to 25 incidents in 2006. In all, 20 of the 83 incidents in 2003 resulted in lost time away from work, compared to only seven incidents in 2006.

The rising cost of medical care and the utility's predominantly male workforce (median age, 47) contributed to the need for a program that focused on preventing heart and blood vessel disease, said Sharon A. Clark, D.H.Sc., lead author of the study and JEA's health promotion specialist.

"With an aging workforce, we were concerned with making a change to the modifiable risk factors for cardiovascular disease for our employees," Clark said.

While safety has long been a priority at the utility, about a dozen employees started the worksite health program in 1989. The workers had been walking along the bridges in Jacksonville's downtown river area during their lunch hours and decided they wanted a more formal exercise facility, Clark said.

"They approached the company to create a fitness center," she said. "Being a public utility, JEA has to be mindful of where its resources are spent."

The company agreed to provide the space, custodial help and security services, and the employees took out a loan for the equipment. The employees also chose the exercise classes and took over most of the day-to-day administration of what has expanded into seven fitness centers at various company facilities.

"Over the years, the company began to notice benefits to helping workers stay fit," Clark said. "The program has grown to where it is now part of the company's strategic plan."

For the study, JEA teamed up with its healthcare provider, Blue Cross/Blue Shield of Florida and with Pfizer Global Pharmaceuticals in Jacksonville.

With their help, the company expanded its safety and health program into a comprehensive wellness system that includes live and written health education information, health screenings, coaching and an incentive program to encourage participation.

Researchers, collecting mounds of data during the three years of follow-up, attempted to quantify the effects of lifestyle-changing activities aimed at reducing cardiovascular disease risks such as smoking, excess weight, high blood pressure and diabetes.

The backbone of the program is the Health Risk Assessment (HRA), a screening tool that includes measures of employees' health through blood pressure, blood sugar and cholesterol testing. It also includes a 60-question survey that asks about current health status, family history, daily nutrition, physical activity, the use of alcohol and tobacco, safe habits (such as seat belt usage), stress and depression, use of available medical screening tests and gender-related health questions.

The survey ends by asking questions that measure how willing an employee is to make lifestyle changes related to health and safety, and providing coaching to accomplish that change.

"Just knowing about something doesn't make you change," Clark said. "So the last part of the HRA is one-on-one coaching."

Employees are asked what they want to change first, such as weight, blood pressure or diabetes control. The coaching, set up through the health insurance company, is structured so that patients can call the same coach repeatedly to build a dialogue.

The researchers also used a Wellness Inventory Survey (WIS) to gather data and provided incentives such as time off or the chance to win prizes for participating in the survey and other aspects of the health and safety program.

The survey includes questions about absenteeism (time away from work due to illness) and presenteeism (unproductive time spent at work due to health or personal situations that make it hard to concentrate). During the study, the percentage of employees with normal blood pressure increased from 28 percent to 37 percent and the percentage with normal blood glucose (sugar) increased from 43 percent to 58 percent. The percentage of non-smokers increased from 86 percent to 89 percent.

Employees also reported feeling better about themselves, with a significant increase in the percentage describing their health status as "excellent or very good," jumping 22 percent from 41.7 percent to nearly 51 percent.

"We are planning to continue to work with modifiable risk factors because we think it benefits both the employees and the employer," Clark said.