No abstract

This randomized controlled trial was designed to determine whether practising stress management techniques would decrease activity and promote psychosocial functioning in inflammatory bowel disease patients. Eighty ambulatory adults received a pre-intervention interview, at which time baseline data about disease activity and psychosocial functioning were collected. They were then randomly assigned to either the intervention or control group. The intervention group received six classes on stress management which included autogenics, personal planning skills and communication techniques. All 80 subjects were followed up at 4-month intervals for 1 year by interviewers who were blind to group designation. The data collection instruments, which were used at all assessment points, comprised three questionnaires: the Crohn's Disease Activity Index (CDAI) and the Inflammatory Bowel Disease (IBD) Stress Index. These instruments produced scores which decreased with improvement in physical and psychosocial well-being. At all assessment points, both the CDAI and IBD Stress Index scores dropped significantly (P less than 0.05) from baseline in the treatment group. However, there was no significant change in the scores of the control group throughout the study year. There were no significant changes in medications at any assessment point in either group that could account for changes in the scores. The results of this study indicate that stress management techniques may have therapeutic benefits for IBD patients.

A T the present time, physicians in private practice are largely responsible for the delivery of health care in North America. Most surveys in the past have shown that these practitioners have been successful in getting no more than 30% of the total hypertensive population under good blood pressure (BP) control.1 " 3 The main reasons documented for this poor rate of success are low detection rates, high treatment dropout, and low compliance with medication. 4 An additional problem found in the studies is the lack of therapeutic vigor in the application of antihypertensive therapy by many physicians.

SUMMARY In this randomized controlled trial, the value of using occupational health nurses (OHNs) to monitor the care of hypertensive employees at work was compared with regular care (RC) delivered in the community. One year after entry, the blood pressure level, medication history, compliance with treatment, and cost of hypertensive care of the participants were determined by independent evaluators. The reduction in diastolic blood pressure (DBP), the measure of effectiveness, was 10.5 ± 1.1 mm Hg (mean ± SEM) in the OHN group and 7.7 ± 1.1 mm Hg in the RC group, and the proportion under good blood pressure control was 41.8% and 31.0% respectively. These between-group differences were not statistically significant. Although the employees in the OHN group were more medicated and had a lower treatment dropout rate, neither difference was statistically significant. In addition, the proportion of employees who were compliant with prescribed medication was virtually identical in both groups. The cost of the care received by employees in the OHN group of $404.14 for the year was substantially higher than that of $250.15 in the RC group with the difference principally related to the cost of visiting the OHNs and a significant difference in drug cost (p < 0.006). The incremental cost-effectiveness (C/E) ratio of $53.67 per mm Hg DBP reduction per year for onsite blood pressure monitoring was higher than the base C/E ratio of $32.65 per mm Hg for regular care. Our findings indicate that monitoring the blood pressure of hypertensive employees at work is neither clinically effective nor cost-effective. Moreover, there is still a significant gap between the control of blood pressure that is potentially achievable when a systematic aggressive approach to treatment is adopted compared with the usual care being delivered in communities at present. (Hypertension 5: 828-836, 1983) KEY WORDS • cost-benefit analysis • allied health personnel * ambulatory care • industrial medicine • delivery of health care • hypertension • occupational health services • patient acceptance of health care I N recent years, the workplace has become a popular focal point for hypertension control programs. Model programs have shown that hypertension screening, treatment, and follow-up can be successfully and efficiently accomplished at work, and the superiority of some of these programs over conventional care has been documented.1 " 4 For example, we found that the provision of care at the worksite by a hospital-based health-care team consisting of two specially trained nurses and a supervising physician was significantly more clinically effective and cost-effective than delivery by community physicians.3 -