Drug Education and Intervention in the Workplace

Appropriate medical care or allied health professional trained in measurement of Blood Pressure, referral protocols, and delivering educational messages to participant delivering Blood Pressure programs. These programs are needed to follow national ground rules.

• National ground rules for Blood Pressure (BP) protocols:
   o Calibration of Blood Pressure (BP) measuring equipment
   be done at least each year.
   o Two or more measurements of colleague’s Blood Pressure (BP) should be taken.
   o Referral of participants with elevated Blood Pressure readings to personal physician for further assessment.

• Systolic/Diastolic Follow-Up:
   o Normal:   <130 / <85
      Action: Recheck in 2 years
   o High Normal:   130-139 / 85-90
      Action: Recheck in 1 year

• Hypertension:
   o Stage 1 (Mild):   140-159 / 90-99
      Action: Confirm within 2 Months.
   o Stage 2 (Moderate):   160-179 / 100-109
      Action: Refer to source of care within 1 month.
   o Stage 3 (Severe):   180-209 / 110-119
      Action: Refer to source of care within 1 week.
   o Stage 4 (Very Severe):   >210 / >120
      Action: Refer to source of care immediately.

• Appropriate educational messages:
   o Normal:   <130 systolic and <85 diastolic
      Action: No referral. If on treatment, then inform attendant that Blood Pressure is under great control today and must continue seeing and following treatment program.
   o High Normal:   130-139 systolic and/or 85-89 diastolic
      Action: Recommend that attendant have Blood Pressure rechecked within 1 year unless under treatment. Advise attendant that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to reduce Blood Pressure is to bring weight into normal range and to exercise.
   o High:   >140 systolic and/or >90 diastolic
      Action: Refer to physician for further evaluation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise participant of readings and need to get Blood Pressure to a objective of 140/90 or less.
   o Isolated Systolic Hypertension:   140-159 systolic and < 90 diastolic in a participant 65 years of age or older.
      Action: Advise attendant to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.
   o Urgent:   180-209 systolic and/or 110-119 diastolic
      Action: Recommend obtaining medical care assessment within 1 week.
   o Emergency:   >210 systolic and/or >120 diastolic
      Action: Obtain immediate healthcare attention.

• Provides the following:
   o Written results, referral guidelines, and an explanation of Blood Pressure levels given to each participant with individualized counseling, including advice about the interval of time recommended when the participant should be checked again.
   o Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, March 1994.
   o Written and audiovisual materials that are informative, easy to be aware of, and useful while containing scientifically accurate information.
   o Relationship of elevated Blood Pressure and other risk factors, such as family history, smoking, high fat and unhealthy diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.
   o Definition and causes of high Blood Pressure (BP).
   o Importance of following prescribed treatment.

Health risk evaluation programs must be carried out on a one-on-one basis by trained health care professionals. Health risk measures must include the following:

• Blood Pressure (BP) measurements – at least two Blood Pressure (BP) measurements taken during the assessment episode, using a mercury sphygmomanometers or regularly calibrated aneroids.
• Blood Pressure treatment status – determine whether the colleague is under a doctor’s care, on any medication, on a prescribed diet, or any other sort of treatment for hypertension.
• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer providing immediate feedback to the client, or sending blood to a laboratory providing feedback using a method that is as effective as immediate feedback.
• Cholesterol treatment status – determine whether the client is under a doctor’s care, on any medication, on a prescribed diet, or any other sort of treatment for high cholesterol.
• Obesity – utilize an accepted method for estimating obesity. For example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.
   o Identify people 20% or more above their ideal weight.
• Smoking status – evaluate whether the colleague currently smokes cigarettes, whether the client has quit or never used tobacco, and the number of cigarettes used tobacco/day.
• Exercise habits – assessment questions may be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.
• Diabetes – whether the client has diabetes, and whether or not it is currently under control. A blood glucose may be also done via finger stick and desk top analyzer. Several manufactures make available cassettes which include blood lipid and glucose measurements.
• Cerebrovascular disease or occlusive PVD – ascertain if the client has had a stroke or other kind of blood vessel disease.
• Family history of cardiovascular disease – determine whether any of the participants’ parents or siblings had a heart attack or sudden death due to heart disease before age 55.
• Coronary heart disease – determine if the client has had a heart attack or other sort of coronary heart disease.
• Stress – colleague’s assessment of stress in work and/or personal life. A series of well-tested and validated questions assessing levels of stress are available from the Worker Health Program.
• Participant release form (see forms) – A release form is necessitated in which the participant authorizes the program to draw blood for testing to send information to the participant’s medical care provider if medical care risks are identified, and to get information from the provider about diagnosis and prescribed treatment.
• Participant interest survey – if an assessment of interest has not been gathered previously, the assessment exercise must assess levels of interest in programs such as: weight control, tobacco cessation, fitness or exercise, stress management, diet, self-care, blood lipid control.
• Health education messages – the screener must review with the colleague his/her identified health risks and what they mean to the colleague’s overriding health, and give the colleague a written record of the Blood Pressure, total cholesterol, and any other physiological measures taken.
• Referral of participants for treatment – participants with elevated risks must be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized guidelines for such referral.

Demographic information should include location of the evaluation, worksite, client’s name, address, social security number, work and home phone number, sex, race, birthdate, relevant job information (e.g., hourly or salaried), department number, and work shift.

Program directors or providers should have a background in wellness programming and a professional health-related degree or certification. They should have expertise in content areas, planning, promotion, administration, evaluation, and ability to grow a program and tailor the program to the workplace.

Program providers must have a quality assurance program for evaluating the effectiveness of service personnel, to assess satisfaction of participants, and for personnel training and continuing education.

An central policy statement ought to be available from directors and program vendors addressing the following concerns: assurance of confidentiality of health data, referral to healthcare for at-risk participants, follow-up with referred participants and those at-risk, program evaluation on process and outcomes, corporation of the worksite for promotion of wellness and changes in corporate culture. A clear contract or letter of agreement for services ought to be provided.

Stay away from being the “best” or doing the “most.” Encouraging employees to be the best or doing the most promotes excessive behavior, discourages others, and creates elitism. The best designed incentive programs are ones which are based on achieving objectives and goals that are attainable by most individuals. Recognition, acknowledgment by top management, or special privileges are examples of great intangible incentives and rewards.

Incentive ideas:

• Free or Low-Cost:
   o Certificates
   o Movie passes
   o Recognition in employee newsletter
   o Mugs
   o Water bottles
   o Commendation from management
   o T-shirts
   o Hats

• Moderate Cost:
   o Entertainment tickets
   o Sweatshirts
   o Waist packs
   o Subscriptions to health magazines
   o Health and fitness books
   o Videos

• High Cost:
   o Week-end getaways
   o Dinner for two
   o Clocks
   o Watches

• Others:
   o Cash
   o Gift certificates

Utilizing posters, newsletter articles, and handouts are great means of promoting the program. Other promotional methods to consider are e-mail and announcements at employee gatherings. Ask Workplace Health Promotion Program Committee members to recruit participants.

Once the program is kicked off you may want to offer an incentive for any employee who recruits another employee to any of the program offerings.

When selecting a program from a vendor you ought to ask the following questions:

• How many worksites have done the program?
• What types of employee population was the program available?
• What educational materials are used?
• Will the program meet the needs of workers?
• What are the techniques used to help shift behaviors?
• Does the program help workers move through stages of readiness to make health behavior changes?
• How do you market the program to workers?
• What follow-up do you support?
• How do you make referrals for health care or other supportive services employees may need?
• How do you know the program works?
• How do you measure attendant satisfaction?

When staffing your wellness program you need to consider whether to hire a wellness employee or contract with wellness professionals from outside your organization.

Small and medium size worksites do not usually have a wellness professional on employee. If your worksite is in this category, you will need to contract with providers outside your organization.

Large businesses have several options. They can hire a employee solely for the wellness program, they can contract with outside wellness providers, or they can use a combination of internal employee and outside providers.

When selecting a provider some key questions in the areas of employee, program structure, process, and performance need to be addressed. Each of these key questions is discussed in the following sections.

Staff

Health professionals become wellness professionals when they are trained in the full range of wellness activities. Wellness professionals are generalists who come from a wide variety of backgrounds and schooling. They may be nurses, dietitians, health educators, counselors, exercise physiologists, or have other backgrounds. But in addition to their primary training, they know something about all wellness subject matters, including smoking, stress, exercise, and nutrition. They also know how to engage and support people in making and sustaining health improvements and have great people skills.

Generally, wellness professionals at worksites fall into three broad categories, wellness screeners, wellness counselors, and wellness instructors.

• Wellness screeners introduce workers to the program, take health measurements, collect health-related information, provide initial counseling, and help workers define for themselves what they need and want in a wellness program.
• Wellness counselors work with employees after the assessment to help them establish and carry out a plan to reduce their risks and improve their health.
• Wellness instructors teach classes and minigroups on different health subject matters.

A wellness program in a small business can be staffed by a single employee person who fills all three roles. Larger worksites will use different workers to fill these roles.

When choosing employee or choosing among vendors, ask the following questions:

• Do prospective employees have a range of health backgrounds that will offer appropriate expertise in the subject matters to be addressed?
• Have prospective staff members functioned well as wellness screeners, wellness counselors, and/or wellness instructors?
• Will this employee include staff members from the racial and ethnic backgrounds found in your employee population?
• Is each employee member comfortable with the range of backgrounds found in your employee population, and able to communicate effectively with the various social and educational levels of your staff members?
• Do workers have a warm, but professional, counseling style when interacting with workers?

An yearly plan for the major wellness programs and activities is a useful management tool. This is an great Corporate Health Promotion Program Committee task. Often an activity and wellness theme per month is offered to employees.

Some employers choose to follow a National Health Observances calendar which offers advantages. The materials developed by these various national health employers are very credible. The materials are usually high quality and available no cost or at a nominal expense.

The company benefits from additional publicity that occurs in various media throughout the area related to the national observance. For planning suggestions you may want to utilize the HOPE Publications Wellness Resource Beginning Guide available for free at this Web site.

A Health Risk Appraisal (HRA) is sometimes used in conjunction with a health evaluation. An HRA is a computerized assessment tool which looks at an individual’s family history, health status, and lifestyle. An HRA seeks to identify precursors associated with premature death or serious illness and quantifies the probable impact for each individual.

An HRA instrument is derived from an understanding of the course of a disease. Based on this understanding, useful prediction instruments can be constructed to assess the health risks of an individual. Individuals with a higher number of health risks tend to have more serious health concerns over time.

Drawing attention to their health risks can help clients decrease risk factors which lead to the onset of unnecessary disease and subsequent premature death. The questionnaire covers lifestyle habits (such as smoking, Seat Belt use, and exercise) and physical measures (such as blood lipids, Blood Pressure levels, height, and weight).

For accuracy, it is crucial to get direct measures of Blood Pressure (BP), cholesterol and HDL-cholesterol. The HRA also supports recommendations and indicates what risks are modifiable. Types of measures to assess health risks are discussed under Screening Programs.

The influence of a health risk appraisal is much greater when it is given in-person, with immediate feedback to the client. This also supports an opportunity to invite the client’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them.

A health age can be computed based on the individual answers to the questionnaire and physiologic factors. The health age may indicate the individual to be younger or older than their chronological age.

HRA programs are one the most prolific types of wellness activities utilized by companies. Continuing research on HRAs is examining the efficacy of this tool. One of the big advantages of this tool is that it can provide an aggregate group report of a company and can be utilized as an assessment tool.

Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on HRAs.

The most common assessment performed in Corporate Wellness Programs is heart health assessment.

The assessment can include a written heart health test, Blood Pressure (BP) measurement, cholesterol/HDL-cholesterol test, glucose (blood glucose), weight, educational materials specific to diet, nutrition, exercise, blood lipids, smoking, and weight.

The health professional conducting the assessment then provides a consultation and helps set objectives and goals with the participant.