Clinical effectiveness and cost-effectiveness of monitoring blood pressure of hypertensive employees at work.

Abstract

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 -

Physician Effectiveness in Interventions to Improve Cardiovascular Medication Adherence: A Systematic Review

“…The three work-site interventions provided hypertension care by a nurse 27-28 or physician 29 ; improvement was shown only in the study in which a nurse was acting with relative autonomy 27 . Logan 27 examined the effect of hypertension care for 457 patients administered by a specially-trained nurse at the worksite.…”

Economics of Team-based Care in Controlling Blood Pressure

“…Of ten studies, the mean SBP after the effect of intervention was >140 in three studies, 18,23,29 115–140 in seven studies, 20,21,25,30,33–35 and <115 in no studies. Of nine studies, the mean DBP after the effect of intervention was >90 for two studies, 27,28 70–90 in six studies, 18,23,29,30,33,35 and at 68.8 in one study. 20 Based on these means, it is likely that the reductions achieved in SBP/DBP from the interventions in this review fell within the beneficial range.…”

“…Based on 29 observations from 20 studies, the median intervention cost of TBC was $284 per person per year (interquartile interval [IQI]: $153 to $670). The median intervention cost was $359 for studies 6,17,20–22,24,25,27,28,30,34 that were reasonably complete in their accounting of intervention cost, $198 per person per year for studies 17–22,27,28,31,33,34 that focused solely on BP, and $225 for studies 17,20–22,27,28,34 with both features. The cost of intervention was smaller where the focus was on BP control compared to interventions with one or more additional objective(s).…”

“…Ten of the estimates from 10 studies 17,24,35,36,38,40–43,45 were negative, indicating healthcare cost savings. With the focus on 11 studies 17,22,24,27,28,33,35,36,38,41,42 that provided reasonably complete accounting, the median was a healthcare cost saving of $77 per person per year (IQI: –$436 to $98). Seven 17,24,35,36,38,41,42 of these studies reported estimated healthcare cost-savings from TBC.…”

“…For seven studies 17,27,28,32–35 that reported both intervention cost and healthcare cost, the sum of the costs was computed as an estimate of the total cost of TBC, producing a median cost per person per year of $329 (IQI: $190 to $658).…”