White Nicole D, Lenz Thomas L, Skrabal Maryann Z, Skradski Jessica J, Lipari Louis
Associate Professor, Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE.
Professor, Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE.
Am Health Drug Benefits. 2018 Jun;11(4):177-183.
Cardiovascular disease remains the leading cause of death in America and poses a significant challenge for self-insured employers attempting to improve employee health and well-being while controlling healthcare costs. Disease state management programs can be an effective means of achieving these outcomes, but the durability and long-term effects of such programs have limited evaluation.
To assess the 5-year health, economic, and quality-of-life patient outcomes of an employer-sponsored disease state management program.
This was a longitudinal, 5-year, quasi-experimental, pre-/postenrollment study. Self-insured health plan members with hypertension, hyperlipidemia, diabetes, or a combination of these conditions met with a pharmacist regularly (monthly for the first year, then varied by participant) to implement lifestyle medicine programs, optimize medication therapy, and facilitate the coordination of care. Biometric markers, lifestyle behaviors, quality of life, and work productivity were assessed on an annual basis.
The significant biometric improvements (mean) seen after 5 years of program participation compared with pre-enrollment included decreased low-density lipoprotein cholesterol levels (96.71 mg/dL vs 84.83 mg/dL, respectively), increased high-density lipoprotein cholesterol levels (39.32 mg/dL vs 46.12 mg/dL), and decreased systolic blood pressure (132.04 mm Hg vs 123.63 mm Hg) and diastolic blood pressure (85.75 mm Hg vs 75.83 mm Hg). The average exercise time increased (50 minutes weekly vs 156.04 minutes weekly), as did fruit and vegetable consumption (3.98 servings daily vs 5.27 servings daily). The program participants reported improved general health and a reduced number of unhealthy days. The combined healthcare and productivity return on investment for the program at 5 years was $9.64 for every $1 invested.
Significant changes in employees' health, well-being, and health-related costs are possible through sustained participation in an employer-sponsored disease state management program.
心血管疾病仍然是美国的主要死因，对于试图在控制医疗成本的同时改善员工健康和福祉的自保雇主来说，这是一个重大挑战。疾病状态管理计划可能是实现这些成果的有效手段，但此类计划的持续性和长期效果评估有限。
评估雇主赞助的疾病状态管理计划对患者5年的健康、经济和生活质量方面的影响。
这是一项为期5年的纵向准实验性入组前/入组后研究。患有高血压、高脂血症、糖尿病或这些疾病组合的自保健康计划成员定期（第一年每月一次，之后根据参与者情况有所不同）与药剂师会面，以实施生活方式医学计划、优化药物治疗并促进护理协调。每年评估生物标志物、生活方式行为、生活质量和工作效率。
与入组前相比，参与该计划5年后观察到的生物标志物显著改善（平均值）包括低密度脂蛋白胆固醇水平降低（分别为96.71mg/dL和84.83mg/dL）、高密度脂蛋白胆固醇水平升高（39.32mg/dL和46.12mg/dL）、收缩压降低（132.04mmHg和123.63mmHg）以及舒张压降低（85.75mmHg和75.83mmHg）。平均运动时间增加（每周50分钟和每周156.04分钟），水果和蔬菜摄入量也增加（每天3.98份和每天5.27份）。该计划的参与者报告总体健康状况有所改善，不健康天数减少。该计划5年的医疗保健和生产力投资回报率为每投入1美元回报9.64美元。
通过持续参与雇主赞助的疾病状态管理计划，员工的健康、福祉和与健康相关的成本可能会发生显著变化。
