PPA Educational Foundation Grant Report 2013 Kristin M. Franks

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1 PPA Educational Foundation Grant Report 2013 Kristin M. Franks The impact of an Incentivized Employer-Driven, Pharmacist Run Know Your Numbers Clinic Kristin M. Franks, Pharm.D., Suzanne Higginbotham, Pharm.D., BCACP, Duquesne University Pittsburgh, PA Abstract Objective: Has an employer-directed, incentivized wellness program shown positive health outcomes in the employee group by improvement in total cholesterol, HDL, BMI and diastolic blood pressure from baseline? Design: Quasi experimental, retrospective chart review Setting: The study took place at an educational pharmacist-managed ambulatory care clinic located on the campus of Duquesne University. Patients: Subjects included Duquesne University employees with active university health insurance who had completed the screenings for two consecutive years Intervention: wellness screenings provided by a clinical pharmacist Main outcome measures: Improvement in total cholesterol, HDL, BMI and blood pressure from baseline. Results: The retrospective chart review shows a significant change from baseline for total cholesterol and LDL. Of the participants in the retrospective chart review 58 (40.5%) at time of review were found to be enrolled in another program at the Center for Pharmacy Care. There were 186 survey participants (43.3% response rate). The majority of participants (155, 83.3%) felt the program increased their awareness of personal health. Discussion: While this study had several limitations it did create various opportunities for future studies. It shows that participants felt there was a benefit to participating and a desire to participate in the future in pharmacist managed services at the Center for Pharmacy Care. Background Duquesne University is a private, Catholic institution located in Pittsburgh, PA. The university is self-insured, so programs have been developed to assist with cost savings related to health and wellness. The University (need more background on Duquesne University-self insured, etc) initiated a unique incentivized preventative care program to employees for health awareness and promotion called the Know Your Numbers campaign in Spring of The

2 program, offered to all employees who currently hold university health insurance and utilizes the clinical services of pharmacists to provide patient counseling on health and wellness. The employee presents at an on-campus ambulatory center for blood pressure, lipid and body composition assessment as well as counseling by a clinical pharmacist. The employees were incentivized to participate by offering $250 stipend. (need to make this flow to next section)similar employee wellness programs have been utilized at various institutions around the United States. Some of these include Johnson & Johnson which has administered an employee health program since the late 1970s, which has had time to evolve and develop to meet the needs of their employees. Participation among eligible workers stands at 90%, and the average age of those participating is 42 years old. 2 The program consists of an overall health risk assessment, completed at enrollment, and periodic follow-ups based upon individual health risk scores. The number of employers offering a health risk questionnaire increased by approximately 10% in Comprehensiveness varies from company to company; some employers simply offer a risk assessment while others offer general health information. The appeal of these programs is readily apparent, since the cost of employer-sponsored insurance plans continue to balloon proportionately with overall healthcare costs, so any technique that can be utilized to reduce expenses is going to be investigated. Some sources suggest that the cost of health insurance for the average American family has doubled since Assessment of several employer programs have demonstrated the benefits associated with increasing employee awareness of overall health and risks. The past decade has seen extensive debate throughout both the public and private sectors about how to cover and combat the ever increasing costs of health care. One proposed solution is to stop approaching health care as a reactive model and instead treat it a proactive model. The current reactive model takes as its starting point of a chief complaint or history of present illness; instead, the theory goes, attention towards the early detection and prevention of diseases. To maximize effectiveness this model should be individualized, develop over time and adjust to meet the needs of the patient, as well as involve a multidisciplinary team to provide comprehensive care. 4 A project developed at Duke University for heart failure patients showed close to a 50% decrease in cost per patient relative to levels before a proactive program was intiated. 4 Because Duke University is self-insured, this finding was of substantial importance to them, as it directly lowered their health care costs per employee, ultimately to a level below the national average. 4 In the past few decades, there has been a shift in the major cause of death from infectious diseases to chronic diseases. 3 This creates a need for change in the public health approach to combating deadly diseases. A program of health promotion should be implemented which involves a combination of individual environment, physical environment and social environment. These programs should aim to benefit the community as a whole, not just the individual. 3 This corresponds with the national health initiative Healthy People Healthy People 2020 is a federal government program which develops national health goals for the next ten years related to public health issues such as immunization rates and employee health programs. These priorities are determined by an assessment the current health

3 problems and any existing gaps. The objective when defining these is to allow for guidance of research and the development of programs. In the most recent update to these goals, there were two headings which directly related to the Know Your Numbers program. This program, as it exists at Duquesne University, meets the objective of a worksite offering an employee wellness program (ECBP-8). The study at hand plans to investigate the effectiveness of our current program as well as determine any existing barriers to involvement. Once these barriers are identified, an effort can be made to ensure that a larger proportion of employees are involved, achieving objective ECBP-9. The existing program meets the objectives shown below, but there is room for improvement. This review will examine Duquesne s health promotion program in its current form, search for areas of potential improvement and provide recommendations on how to best achieve objective ECB-9 to increase employee participation in the Know Your Numbers program. Research has been conducted on employee perspectives on the impact of health awareness programs. One such study was conducted using a qualitative survey which utilized a Lickert-type scale of disagree to agree completely. 6 The results from this study supported the idea that additional research conducted on this topic would improve existing programs to better suit the needs of each employer s workforce. At Ohio Northern University, a pharmacist-led wellness center was started to assist in the medical needs of the employees on campus. A study was subsequently conducted to determine the perspectives of employees and the potential for success of initiating a wellness program for insured employees. The study found that overall, employees were open to the idea of a wellness program. 8 A study of numerous employer programs found that there was an average savings of $358 per employee per year based on data from This research also found that a greater number of preventative services were utilized by participants in programs compared to those not participating. 7 Objectives The current study sought to determine (1) if an employer-directed, incentivized wellness program has shown positive health outcomes in the employee group by improvement in total cholesterol, HDL, BMI and diastolic blood pressure from baseline (2) prove the impact of the program on health literacy. Methods A retrospective chart review was performed. Participants in the study are Duquesne University employees with active insurance through the university. Additionally, they were 18 years of age or older. From this subset of individuals analysis shall was conducted on data from those employees who have participated in the Know Your Numbers campaign for at least 2 years. This will provide us with a baseline and follow up reading.

4 A survey was used to assess current views and opinions of the program as well as knowing their numbers after participating. Participants were notified via about the opportunity to participate in the survey which will be available in an online format. To assess the employees views of the program and any impact this program has had will be assessed using a a Likert scale as well as direct response questions (Appendix A). This is a non validated survey developed for the purposes of this study. Employees who have participated in the Know Your Numbers campaign were contacted by Human Resources via which will include a link to the survey available through Survey Monkey. Employees who complete the survey were eligible for entry into a raffle for a gift card. Employee name and contact information for participation in the raffle were collated and identifiers hidden from the researchers by Survey Monkey. This study was approved by the Duquesne University Investigational Review Board. Sample size The calculated sample size necessary to achieve an alpha of 0.05 was 54 participants.. Data was collected on 143 participants. The office of Human Resources provided communication with participants eligible for participation in the survey. They identified 430 employees who met the eligibility criteria. Statistical analysis A repeated measures ANOVA was conducted to analyze the within-patient variability of readings. Descriptive statistics were utilized in the analysis of data from the survey. The data was then imported into SPSS 17.0 for the necessary statistical tests to be conducted. Results Retrospective Chart Review A one way repeated measures ANOVA was conducted with the factor being enrollment in the program or not and the dependent variable being diastolic blood pressure, total cholesterol, HDL, LDL, TG and BMI. The means and standard deviations are shown in Table X. The effect size, F, calculated for total cholesterol, systolic and LDL had an effect based upon involvement in the study since the F values were all greater than 1. The results were shown to be significant for total cholesterol (p = 0.014) and LDL (p = 0.002). There are 58 patients ( 40.5%) who were also enrolled in one of the Center for Pharmacy Care s medication therapy management programs. A requirement for participation is completion of a non-fasting cholesterol panel. However, 82 (57.3%) of participants eligible for this study received a fasting lipid panel. Survey

5 For the survey portion 186 participants responded (43.3% response rate). Respondents included 113 female (62.1%) and 55 male (30.2%). The average age was 48 years. There were 27 faculty (14.8%), 86 staff (47.3%), 86 administration (29.7%) and 15 no answer (8.2%). Of respondents 173 (93%) had their numbers (blood pressure, TC cholesterol, HDL, BMI) checked at the Center for Pharmacy Care. The majority of participants (155, 83.3%) answered that the program increased their awareness of personal health, and 175 (94.1) of all respondents stated they would participate at the Center for Pharmacy Care again. Demographics (lab tests)- Table X Number Percent Gender - Male % - Female % # also enrolled in MTM % program # that received a fasting panel % Age Years - Overall Male Female Test Mean Standard Deviations Total cholesterol Total cholesterol HDL HDL Systolic Systolic Diastolic Diastolic BMI BMI LDL LDL Triglyceride Triglyceride

6 Never Sometimes Always No answer Before participation I... Eat vegetables 5 (2.7%) 58 (31.2%) 112 (60.2%) 11 (5.9%) Eat fast food 41 (22%) 126 (67.7%) 7 (3.8%) 12 (6.5%) Exercise 16 (8.6%) 87 (46.8%) 70 (37.6%) 13 (7%) Take my prescriptions as directed/ prescribed 17 (9.1%) 10 (5.4%) 133 (71.5%) 26 (14%) Never Sometimes Always No answer After participation I... Eat vegetables 3(1.6%) 48 (25.8%) 124 (66.7%) 11 (5.9%) Eat fast food 47(25.3%) 124(66.7%) 2(1.1%) 13 (7%) Exercise 6 (3.2%) 82 (44.1%) 86 (46.2%) 12 (6.5%) Take my prescriptions as directed/ prescribed 13(7%) 7 (3.8%) 138 (74.2%) 28 (15.1%) Discussion While the results from the analysis of lab results were not statistically significant there was not a significant increase in lab values. The data collected during the survey indicate that the participants viewed the program to be beneficial. Additionally, they felt that they would participate again with a pharmacist at the Center for Pharmacy Care. Limitations Some limitations of the study include the use of retrospective data. In the year between visits the patient may have made lifestyle changes, started on medications or become ill and therefore values changed regardless of our interventions. Also, since the data was collected from existing charts there is no way to know precisely what education the patient received at their appointment. Another limitation is the fact that the study did not include a control group

7 and involved no randomization. The study found that 58 participants of the retrospective chart review were also enrolled in an MTM program at the Center for Pharmacy Care. Some of the participants were enrolled in the MTM as a result of their initial KYN appointment. However, due to the retrospective nature of this study it was not determined if the enrollment occurred prior to or after KYN appointment. Future Research In the future research can be conducted to include a survey both before and after the Know Your Numbers consulting session to see if the session itself increased patient knowledge. Additionally, a prospective study looking at the patients who were enrolled in one of the many Medication Therapy Management programs at the center based upon this appointment and the associated benefit on their numbers could be studied. In addition, this allows for baseline information for future comparisons. References: 1. Healthy People Web site. Updated Accessed July 25, Goetzel RZ, Ozminkowski RJ, Bruno JA, Rutter KR, Isaac F, Wang S. The long-term impact of Johnson & Johnson's health & wellness program on employee health risks. JOEM. 2002;44(5): Navarro AM, Voetsch KP, Liburd LC, Giles W, Collins JL. Charting the future of community health promotion: Recommendations from the national expert panel on community health promotion ;4(3):1. 4. Snyderman R, Dinan MA. Improving health by taking it personally. JAMA. 2012;303(4): Hochart C, Lang M. Impact of a comprehensive worksite wellness program on health risk, utilization, and health care costs. Population Health Management. 2011;14(3): Nohammer E, Stummer H, Schusterschitz C. Improving employee well-being through worksite health promotion? the employees' perspective. Journal of Public Health. 2011;19: Williams L, Day B. Medical cost savings for web-based wellness program praticipants from employers engaged in health promotion activities. American Journal of Health Promotion. 2011;25(4): Bright D, Terrell S, Rush M, et al. Employee attitudes toward participation in a work site-based health and wellness clinic. Journal of Pharmacy Practice. 2012;00(0):1.