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Biomedical subjects

J C Erfurt

Publications and source records attributed to J C Erfurt.

At least 19 recordsLinked to original sources
PubMed1993

Work-site physical fitness programs. Comparing the impact of different program designs on cardiovascular risks.

The relative impact of three different approaches to physical fitness at the work site on cardiovascular risk reduction is examined, based on before/after health screening of employees, and employees' reports of participation in physical exercise activities. The three approaches tested were: 1) a staffed physical fitness facility, 2) one-to-one counseling with at-risk employees, and 3) a combination of one-to-one counseling with employees plus organization of the work site to encourage peer support and mutual exercise activity at work. A fourth site is used as a control site. The program that was centered around a physical fitness facility had little measurable impact on cardiovascular risks, and showed results similar to those at the control site. Both of the other programs were more effective, with the combination of counseling and plant organization providing the best health outcomes in terms of frequency of exercise, adequacy of blood pressure control (among hypertensives), weight loss (among the overweight), and smoking cessation. These results indicate that systematic, ongoing outreach to enlist employees in various types of exercise programs is more effective than the presence of fitness facilities without such outreach. Moreover, significant increases in frequency of exercise can be sustained without a substantial investment in facilities.

Cardiovascular Diseases↗
PubMed1992

The core technology of work-site wellness.

Work-site wellness programming his evolved through four stages of development. This article proposes a core technology of work-site wellness programs comprised of 10 dimensions that organize and systematize the range of activities undertaken by such programs. These 10 dimensions address the following tasks: (1) establishing program policy, (2) assessing the health status of the work force, (3) linking the work site with service providers, (4) linking individual employees with services appropriate to their needs, (5) providing options for behavior change strategies and interventions, (6) engaging employees in these various interventions, (7) organizing work-sitewide activities to support health improvement, (8) reviewing and altering organizational policies to make the work environment more supportive of health, (9) routinely evaluating program process and changes in health risks, and (10) periodically assessing longer-term program results. Two future dimensions are described that require further evidence of impact. Arguments and evidence in support of each dimension are provided, including discussion on how activities within each dimension work together to produce maximum effectiveness, and how various dimensions relate to each other to make an effective overall program.

Comprehensive Health Care↗
PubMed1991

The benefit to cost ratio of work-site blood pressure control programs.

Reduction in the cost of health care claims among hypertensive employees was examined over a 4-year period after exposure to a 3-year blood pressure control program, to see whether work-site monitoring and counseling produced a subsequent benefit. Hypertensive employees at three experimental sites (N = 183 to 367 subjects) were compared with subjects at a control site (N = 169) who had received no postscreening follow-up or monitoring, and with matched normotensive employees. The cost of subsequent health care claims for hypertensive employees at the experimental sites was lower than claims for those at the control site, but there was no significant difference across the sites in claims for normotensive employees. After adjusting to a standard 1982 dollar, the data showed from $1.89 to $2.72 in reduced health care claims per dollar spent operating the hypertension control program.

Blood Pressure↗
PubMed1991

Health promotion in small business: what works and what doesn't work.

Wellness programs were tested in three sites, representing three different types of small businesses. The sites ranged in size from 296 to 5 employees. The program at each site included: 1) wellness screening, 2) referral to community physicians for high blood pressure or cholesterol, 3) on-site wellness programs, and 4) long-term follow-up counseling. At sites 2 and 3, the respective company paid the full cost of these services; at site 1, the company's financial support was limited to 50% of the cost of screening. Results showed that participation in screening was severely reduced in the third company, and participation in follow-up and wellness programs dropped to zero. In contrast, there was full participation in all facets of the program at the two sites that paid all costs. Twelve-month follow-up data showed improvements in blood pressure, cholesterol, cigarette smoking, weight control, and oxygen uptake.

Health Promotion↗
PubMed1991

Effects of EAP follow-up on prevention of relapse among substance abuse clients.

Clients entering an employee assistance program (EAP) of a large manufacturing plant in 1985 who were assessed as having an alcohol or drug abuse problem (N = 325) were randomized into an experimental "special follow-up" group and a control "regular care" group. The regular care group received follow-up only as needed (following the usual practice of the EAP), while a follow-up counselor was hired to make routine contacts with the special follow-up group. Study intake continued through 1985, and follow-up continued through the end of 1986. Data collected on study subjects included EAP participation data, absenteeism, number of hospitalizations, health care claims paid and disability claims paid. The major study hypothesis was that EAP clients randomly allocated to special follow-up would show better results than regular care clients (i.e., would have fewer relapses, better job attendance and lower health benefit utilization during the follow-up year). The follow-up intervention was incompletely implemented due to a variety of organizational problems. Differences between the two groups on the six outcome measures were not statistically significant, although clients in the special follow-up group did show better results than clients in the regular care group on the three measures related to substance abuse. Differences on these three measures were marginally significant in regression analyses after controlling for the effects of number of follow-up visits, age, race and chronicity.

Adult↗
PubMed1991

The cost-effectiveness of work-site wellness programs for hypertension control, weight loss, and smoking cessation.

The cost-effectiveness of work-site wellness programs for reducing cardiovascular disease risks of employees was examined at three manufacturing plants. A fourth plant was used as a control site to estimate levels of risk reduction achieved from wellness screening and preexisting services, without further interventions. The cardiovascular disease risks included in the study were hypertension, obesity, and cigarette smoking. The annual direct cost per employee for postscreening interventions was $2.97 for site 1 (control site), $17.68 for site 2 (health education), $30.96 for site 3 (health education plus follow-up counseling), and $38.31 for site 4 (health education, follow-up counseling plus plant organization for health promotion). Of the three experimental sites, sites 3 and 4 were more effective and more cost-effective than was site 2, both in terms of engaging employees at risk of cardiovascular disease into treatment or program participation and of reducing their risks or preventing relapse. For engaging employees into treatment/program participation, sites 3 and 4 were nine to ten times more cost-effective than was site 2; for reducing risks/preventing relapse, sites 3 and 4 were five to six times more cost-effective than was site 2. At sites 3 and 4, the total direct cost per percent of risks reduced/relapse prevented was less than one dollar ($.67 and $.74, respectively) per employee per year. Program costs may vary considerably across companies because of differences in salary structures and overhead costs. These are held constant in this report for comparison across program models.

Adult↗
PubMed1990

Maintenance of blood pressure treatment and control after discontinuation of work site follow-up.

Participants in a 3-year study of hypertension control at four work sites were rescreened 4 years after discontinuation of the study protocols. At the end of the 3-year study period, employees at the study sites that provided routine follow-up monitoring had shown significantly better levels of blood pressure control than at initial screening and significantly better levels than employees at the site that did not provide follow-up monitoring. But 4 years after discontinuation of the follow-up services this was no longer true. The level of blood pressure control at the experimental sites was no better than at the control site, and the level of control at all study sites was no better than would have been predicted for a population that had aged by 7 years. Some 17.6% of the participants were found to be in remission (with normal blood pressure readings, not under treatment), but the data suggested that they were at risk of future blood pressure elevations, warranting continued monitoring. The major predictor of continuation in treatment was frequency of blood pressure monitoring, but frequency of monitoring was not associated with maintenance of good control. It is concluded that follow-up monitoring programs at the work site should be treated as permanent services, not short-term programs.

Clinical Protocols↗
PubMed1990

Worksite follow-up and engagement strategies for initiating health risk behavior changes.

Information is presented from a multiplant study of interventions to improve cardiovascular health among employees. Risk factors targeted were high blood pressure, obesity, and cigarette smoking. The study utilized on-site wellness counselors who periodically contacted all employees identified through screening as having one or more of the three risks. Use of a structured protocol for client outreach resulted in the large majority of clients being seen in follow-up during the three-year intervention period. Drawing from caseload experience and from various theoretical perspectives, seven engagement strategies were used to help guide at-risk clients toward successful behavior changes to reduce health risks. Results showed that of the three at-risk groups, clients with high blood pressure were most likely to be seen in follow-up, and most likely to begin a risk reduction program. For the overweight and smokers, clients seen three or more times were more likely to begin a weight-loss/smoking cessation program than clients seen less often. Frequency of follow-up showed a positive relationship with risk reduction for all three risks, in samples of employees rescreened at the end of the intervention period, but the relationship was not statistically significant for smoking cessation.

Cardiovascular Diseases↗
PubMed1990

Evaluating worksite CVD risk reduction programs.

If a program is worth doing, it is worth evaluating. Before evaluating, specify program objectives, and keep the evaluation focused on those objectives. If the objective is to reduce risks, then count the number of risks reduced, and divide by the total number of risks. Use evaluation procedures that will be of use to program staff in making improvements. CVD risk reduction programs are ongoing. Today's lowered risk is tomorrow's relapse.

Cardiovascular Diseases↗
PubMed1988

Posttreatment follow-up, aftercare, and worksite reentry of the recovering alcoholic employee.

A review of literature on the effects of aftercare in the treatment of alcoholism reveals mixed results, with some studies showing positive effects and some showing no effects. However, few studies controlled for bias in the process of selection into aftercare, and many of the studies reveal significant difficulties in engaging patients into aftercare. The relapse prevention model is reviewed as a potentially powerful tool for use in aftercare. The literature on worksite reentry of alcoholics shows a generally positive correlation between employment and recovery, but does not produce unambiguous findings regarding the direction of the relationship. A nontraditional, proactive approach to aftercare is proposed, based on studies of other types of health problems that show improved results with this approach. It is argued that the worksite is the most appropriate place to locate aftercare services for employed alcoholics, particularly worksites with employee assistance programs. However, further research is needed to guide the development of these services.

Aftercare↗
PubMed1984

Cost-effectiveness of work-site blood pressure control programs.

The cost-effectiveness of work-site hypertension programs was examined at three manufacturing plants. A fourth plant was used as a control site to estimate expected levels of hypertension control from screening without further intervention. The annual cost per hypertensive employee of the three intervention programs was $26.26 for semiannual follow-up, $35 for full follow-up, and $96.19 for on-site treatment. Each intervention resulted in an additional 1% of hypertensive employees maintained under control, per dollar spent annually, with the highest cost per unit of effectiveness being incurred for free on-site treatment. Cost-effectiveness may vary considerably, however, depending on the additional costs a company may incur as a result of program adoption.

Adult↗
PubMed1983

Hypertension control at the work site. Comparison of screening and referral alone, referral and follow-up, and on-site treatment.

Four methods for improving hypertension control among employees were tested in one manufacturing plant each: screening and referral to a physician but no other intervention; referral to a physician and semiannual follow-up; referral to a physician and more frequent follow-up as needed; and on-site treatment or care by a family physician. All methods significantly increased the proportion of subjects under treatment, but only the three programs offering follow-up or treatment significantly improved the adequacy of control. At the end of the three years of the project, 56 to 62 per cent of the hypertensive employees in these three programs had blood-pressure readings below 140/90 mm Hg, and 86 to 90 per cent had readings below 160/95. In contrast, among employees who received no intervention after screening, only 21 per cent had readings below 140/90 mm Hg at the end of the study, and only 47 per cent had readings below 160/95. Employees selecting on-site treatment had the highest level of blood-pressure control, but this finding appeared to be due to self-selection of previously untreated patients into on-site treatment and to exclusion of employees with other medical problems. We conclude that work-site hypertension programs can produce substantial improvements in blood-pressure control if they include systematic, routine follow-up that provides employees with information about their condition and offers support for maintenance of therapy.

Adult↗
PubMed1979

A hospital-based screening, referral, and follow-up program for high blood pressure.

A hypertension program staffed largely by volunteer nurses in a hospital outpatient department is described. A three-year evaluation shows 19% of 4,282 clients screened as having high readings, 86% of those referred saw a physician for high blood pressure, 92% of those who saw a physician began treatment for high blood pressure and 50% of those under treatment were showing successful control or progress toward successful control.

Evaluation Studies as Topic↗