Drug Education and Intervention in the Workplace

Company America is increasingly investing in employee wellness because it is great business.  In order to meet productivity demands, organizations must rely on a healthy, constructive workforce to succeed in the highly competitive global marketplace.  Over a hundred research studies in both corporate and governmental settings have documented the economic benefits of Workplace Wellness Programs, including reduced absenteeism, reduced injuries and workman’s compensation costs, reduced healthcare costs, reduced employee turnover, as well as increased productivity, greater worker satisfaction, and improved morale.1-10  

The more recent literature reflects improvements in wellness programming along with greater return on investment (ROI).  In general, the more focused and intensive the program, the greater advance realized.  To enhance their effectiveness federal government Company Health Promotion Programs may be able to incorporate some of the features described.  Employee wellness programs established to have positive returns on investment frequently include the following features:

1.   Health and work rate management model
Programs characterized by this model focus attention on identification and reduction of specific risks or behaviors such as smoking, lack of physical activity, excess weight, unhealthy diet, high blood lipids, high Blood Pressure, stress, depression, and so on.  High-risk employees are specifically targeted for intervention, although the most efficacious programs also direct efforts towards healthy employees in order to maintain their low-risk status.  This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.  

2.   Health risk appraisal
Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in thriving programs.  Staff Members take the questionnaire annually in many cases.  The HRA serves to expand awareness, offer direction, and motivate individuals to better specific behaviors.  In some cases, the personalized report is directly linked to appropriate resources related to identified risks.  Research indicates that the use of an HRA is effective if it is followed by some kind of educational or therapeutic intervention for identified risks.  It frequently serves as the entry point into wellness programs.

3.   Biometric Testing
Many programs combine the results of the health risk appraisal with measurement of each employee’s biometrics, including weight and Body Mass Index (BMI), Blood Pressure (BP), cholesterol, fasting glucose, and assorted other metrics.  Combining the results of the HRA with biological measures results in a more accurate risk profile.   Computer health risk appraisals frequently incorporate biometric data in their risk analysis.

4.   Incentives
employees are usually given monetary or other significant rewards for completing an HRA, participation in a program or class, specific accomplishments such as stopping smoking, losing weight, or working out, and for maintaining healthy status and/or behaviors.  In numerous cases the monetary incentives are associated with reductions in health care insurance premiums.  Some programs use disincentives as well as incentives, such as charging employees who use tobacco higher rates for their health care insurance contribution.

5.   High participation rates
Successful programs use incentives to drive participation rates up.  They also market their programs extensively, and may use contest or challenge strategies to heighten enthusiasm and encourage participation.

6.   Wellness coaching
staff members with identified risks or desire to improve their health habits may be periodically coached via phone by trained health & wellness coaches.  Health and Wellness Coaching helps staff members set and achieve realistic lifestyle-related objectives and goals including those addressing stress, work life balance, smoking, weight, physical exercise, and various behavior modifications.  Three or more sessions are generally available.  In some intensive programs, the coaching extends to actual disease management intervention for staff members with identified elevated-risk diseases.

7.   Multiple formats
Programs may offer wellness content in internet based, paper, and seminar formats to support stimulating variety and alternatives in order to accommodate the needs of all employees.  In addition to on-Site physical exercise and healthy eating activities, on-line programs, e-mail reminders and notices, printed newsletters and materials, and business sessions are common dissemination strategies.

8.   Upper Management backing
Enthusiastic and persistent endorsement by management is vital to achieving high rates of participation.  When senior executives are wellness role models themselves the effects of endorsement are enhanced.

9.   Frequent contact
Effective programs have common contact of some sort with every employee.  This may be through marketing efforts (e.g., posters, e-mail notices, reminders, or messages, etc.), bulletin boards, newsletters, employee meeting presentations, discussion in new employee orientation, supervisory sessions, etc.   The key is to enhance employee awareness of wellbeing and health opportunities and reinforce the corporate emphasis on wellness through common and multiple “touches”.

10.   Open enrollment
To bolster high participation rates staff members must have simple access to the wellness programs and activities.  Open and uncomplicated enrollment processes achieve this.  Some companies automatically enroll all staff members and then allow those who do not wish to take part to “opt-out”.  This practice has been demonstrated to boost enrollment rates in some settings.

11.   Family involvement
Many programs promote spouses and other family members to take part in the organization wellness activities and to adopt a healthy lifestyle along with the designated employee.  It is far easier for the employee to have a healthy lifestyle if his/her family does so as well.

12.   Smoking cessation
Because smoking and other tobacco use is the number one threat to health it is vital to offer workers effective and convenient assistance with stopping.  Access to tobacco cessation pharmaceuticals is frequently part of such programs.  In-house programs provide the most convenient access to these services, although on-line or phone-based programs may be available as well.  

13.   Exercise
Regular physical activity is a core component of every wellness program.  Employees must be strongly encouraged to engage in regular physical activity.  Most programs provide either periodic or continuous worksite opportunities, and some locations have worksite gyms, swimming pools, walking trails, etc.  Discounted or paid memberships to neighborhood exercise facilities is a common alternative to worksite facilities.

14.   Weight management
Because obesity is a major threat to health it is imperative that programs offer effective assistance with weight management.  Enthusiastic encouragement from management to shed excess weight is valuable.  Internet based programs, workplace programs, or discounted access to weight management programs in the area may all be available.  Long-term follow-up is critical for maintenance of weight loss.

15.   Stress management
Workplace stress is perhaps the most common objection among staff members and a primary contributor to absenteeism, presenteeism (reduced productivity), and low morale.  Almost all successful wellness programs offer assistance with personal and workplace stress.  Some programs refer staff members to outside resources for more serious conditions like depression and anxiety disorders, but most offer internet based or frequent workplace general stress reduction programs.  Some organizations endeavor to structure the work environment to minimize stress, both physically and operationally.

16.   Health screenings/immunizations
workers are actively encouraged to complete recommended medical care screenings for Blood Pressure, cholesterol, BMI, colorectal and breast cancer, and others.  Annual influenza immunizations are also encouraged.  Some sites offer these services at the worksite.  Incentives are frequently awarded for completion of these screenings/immunizations.

17.   Onsite medical care
Actual provision of onsite primary care medical services is a growing trend.  The rapidly escalating costs of medical care insurance for staff members has stimulated this trend.  Some businesses have found that it is less expensive to support primary care services themselves than to fund those services through health insurance.  Onsite care also reduces the amount of time staff members would otherwise spend away from the worksite getting such services.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Employee Health Promotion Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
3.   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion:  Is it Really As Important as We Think?  The Art of Health Promotion  7(2):1-12.
4.   Chapman, Larry.  (2005)   Meta-Evaluation of Worksite Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Corporate Health Promotion Programs and Corporate Health Promotion Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Employee Health Promotion Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Job Site Wellness.  Northwest Health Management Publishing, Seattle, WA.
8.   Chapman, Larry.  (2007)   An In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
9.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
10.   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
11.   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Work Productivity.   Journal of Occupational and Environmental Medicine, 46(7): 746-754.
12.   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Disease Management Programs at the Worksite: Update VI 2000-2004.  JOEM 47(10)1051-1058.
13.   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  An Unhealthy America:  The Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.
14.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.