     |
. |
 d
Promoting
Wellness—What Works in Managed Care (aka
Prevention)
This feature of Conwal's MCarePrev website highlights recent
clinical
trials and case studies illustrating:
- enrollee
self care
- cost
reductions
- improved
health outcomes
- other
benefits of behavioral health promotion to managed
care.
Each entry
consists of
- a
reference
citation
- a
summary
of the contents
- a
comment
from Conwal's analytic staff on the implications of the
study.
Entries
are
added monthly—hit this site again soon to view what's
current!
B1001.
J. A. Taylor, R. L. Davis, and K.J. Kemper (1997) Health care
utilization
and health status in high risk children randomized to receive
group
or individual well child care. PEDIATRICS 100:electronic
version.
-
Summary.
Well child care uses immunization, physical examinations,
screening,
and parent education to promote effective self care in the
family,
prevent the onset of health problems, and reduce use of
clinical
resources. Well child care is particularly important among low
income populations whose use of emergency departments tends to
be high. This three year controlled trial compared Group Well
Child Care (GWCC) to individually administered well child
visits.
Previous studies found that GWCC offers cost savings, more
opportunity
for parent education, and a surrogate support group for the
parents.
Many of these hoped for benefits did not materialize in the
trial,
in part because the average group size was small (3 families
per
session). However, health care utilization outcomes for
families
receiving GWCC were the same as outcomes for families receiving
traditional well child care.
Comments.
GWCC is an example of prevention that may work best when supplied
by a community based prevention contractor rather than by a
physician.
Appropriate group sizes and maintenance of the benefits of a
parent
support group may be less of a problem when one agency provides
GWCC for all enrollees in a neighborhood, regardless of the
clinician
provider.
B1002.
A. Gadomski, D. Wicks, K. Abernathy, C. Lewis, and T. Pearson.
(1997)
Providing preventive services in a rural area through a public
private
partnership. AMERICAN JOURNAL OF PUBLIC HEALTH
87:1375-1376.
-
Summary.
When Bassett Healthcare and the Otsego County Health Department
jointly assessed community health needs, they discovered:
- Only
25% of the county water supply is fluoridated;
- Otsego
ranks among the top counties in New York for motor vehicle
hospitalizations;
- Surprising
rates of other preventable health problems and
injuries.
The MCO
and the country created a Public Health Partnership with an
annual
budget of $130,000, that distributes health "tips,"
trains public school teachers at an annual workshop on
classroom
health education, promotes fluoride rinse, and organized county
coalitions to prevent violence and drunk/drugged driving.
Medical
and nursing students augmented the Partnership staff and
stretched
the health education resources.
Comments.
The Partnership gets a lot of health promotion for a small
investment
...and the MCO gets name recognition, solid information on
community
health problems, and a reputation for caring about patients, all
of which are valuable for a small MCO that needs to retain
enrollee
loyalty against national competition.
B1003.
A. Franzgrote, J.M. Ellen, S.G. Millstein, and C.E. Irwin. (1997)
Screening for adolescent smoking among primary care physicians in
California. AMERICAN JOURNAL OF PUBLIC HEALTH 87:1341-1345.
-
Summary.
This study identified correlates of screening adolescents for
smoking behavior. Rates of screening for regular smoking among
11 to 14 years old patients during routine exams varied from
61%
for pediatricians to 85% for specialists in adolescent
medicine.
Screening rates for having tried tobacco are more
uniform:
11 to 20%. Higher rates were reported for screening older
adolescents.
Comfort levels in dealing with adolescents and with smoking
cessation
counseling have a positive influence on screening rates during
early adolescence, when smoking is likely to start.
Comments.
Smoking cessation and antitobacco counseling now are HEDIS
measures
for MCO performance. MCO sponsored in service training for
clinicians
on how to talk comfortably to adolescents about tobacco could
help
raise screening and counseling rates.
B1004.
F. Soto, R.L. Papenfuss, and J.J. Guerrero. (1997) Hispanics and
worksite health promotion: Review of the past, demands for the
future.
JOURNAL OF COMMUNITY HEALTH 22:361-367.
-
Summary.
The authors note that rapidly increasing Hispanic employment
will
alter the effectiveness of worksite health promotion in the
next
25 years. Data from multiple sources identify the following as
priority issue areas:
- nutrition
- worksite
safety
- exercise
- tobacco
use and binge alcohol use (particularly for young
men)
- how
to effectively use health benefits.
Soto and
Papenfuss identify worksites as especially appropriate for
addressing
preventive health needs of the Hispanic community, because
their
priority health needs correspond to the health promotion
activities
usually associated with worksites.
Comments.
Most—although not all—of the health issues identified
as "Hispanic"
are issues prevalent among many low income populations. Conwal
worked
with a community provider who taught Hispanic enrollees to
prepare
traditional Mexican and Central American "comfort foods"
with low fat and higher protein...and found non-Hispanic
enrollees
benefit from and like the classes.
B1005.
B. Brewer, M. Stein, and D.E. Williams. Roving Rural Respite Care
for the Elderly. Presented to the 125th Annual Meeting of the
American
Public Health Association, Indianapolis, November 11,
1997.
-
Summary.
Family care givers of infirm or chronically confused elderly
feel
"trapped"—this can lead to neglect, abuse, and
occasionally
violence. In rural areas, opportunities for intervention are
limited.
The state of South Carolina and a private foundation help
Interfaith
Volunteer Caregivers of Spartansburg to organize roving respite
care, using only two part-time paid staff members. Resources
are
trucked weekly to churches and civic facilities for a half-day
of care and activities for the elderly. A Home Health Agency
provides
screening and counseling. Evaluation tracks positive changes in
client function, caregiver perceptions of burden, and
depression;
the number of cases requiring action by local Adult Protective
Services is declining.
Comments.
Appears to efficiently use limited resources to simultaneously
offer
preventive services to a rural Medicare population and to their
vulnerable care givers.
B1006.
J. Fraze, M. Wilson, J. McLaughlin, and W. LeCroy. Communicating
Health Promotion Within a Large Corporation. Presented to the
125th
Annual Meeting of the American Public Health Association,
Indianapolis,
November 11, 1997.
-
Summary.
The Best Buy retail chain instituted a Well Workplace program
through the use of a network of employees who volunteer to be
health promotion representatives at each store. Important
health
program information and advisories, however, were not reaching
the part-time "wellness reps." A survey sent to 540
employees found that personal communication, such as training
sessions and telephone calls, were most effective in ensuring
the implementation of health promotion messages. The company
had
been relying primarily on newsletters, impersonal memos sent by
facsimile machine, and "awareness kits" to reach the
wellness reps, and did not achieve the desired
changes.
Comments.
This study has implications for worksite wellness promotion in
general:
If employees who are supposed to be leaders in wellness often
ignore
impersonal print messages, then how are such messages supposed to
change the behavior of less receptive employees?
B1007.
T.R. Misener, S.G. Fuller, and H.F. Sharp. Predictions of
Participation
in Health Promoting Lifestyles as a Function of Psychosocial
Development.
Presented to the 125th Annual Meeting of the American Public
Health
Association, Indianapolis, November 11, 1997.
-
Summary.
Why are some men less likely than others to adopt healthy
lifestyles
and to use preventive health care? The authors applied Hawley's
Measures of Psychosocial Development (MPD) and the Health
Promoting
Lifestyle Profile instrument to a random sample of 500 males
from
20 to 50 years old. The authors found statistically significant
correlations between high scores on the Profile and both the
MPD
and each of its six subscales, as well as between high scores
on the Profile and educational level attained. Being single
correlated
with low scores on the Profile instrument; age did not make any
statistically significant difference.
Comments.
The study suggests that psychological maturity is an asset for
health
promotion and that its absence is a barrier. It also suggests
that
the Health Promoting Lifestyle Profile and Pender's Health
Promotion
Model are useful tools for understanding (male) enrollee response
to health promotion activities.
B1008.
W. Greene, B.L. Green, and M.F. Britt. Using Sunday Sermons to
Improve
the Health Behaviors of African Americans: Are They Effective?
Presented
to the 125th Annual Meeting of the American Public Health
Association,
Indianapolis, November 12, 1997.
-
Summary.
Results of a survey of congregants at one Baptist church in
Alabama,
following exposure to "Sunday Health Sermons" found
that 94.4% now viewed the religious service as an appropriate
means for providing health information and that over 70%
associated
a sermon with at least one new action they had taken to improve
their health status.
Comments.
Although too limited to apply to a larger audience, the study
suggests
that a managed care/church partnership might be a cost-effective
approach to reaching some low-income enrollees with effective
preventive
information.
B1009.
K.B. Stroup and L.K. Hawkins. Lowering the Cost of Healthcare for
Indiana's Children: Riley Hospital's Partnership with Wal-Mart
and
Sam's Club Associates. Presented to the 125th Annual Meeting of
the American Public Health Association, Indianapolis, November
12,
1997.
-
Summary.
Describes the "Safety Smart" partnership between the
100 Wal-Mart/Sam's Club stores in the Indiana-Ohio-Michigan
area
and a nonprofit children's hospital. The hospital receives
support
from the retail chain for fundraising for staff and programs,
while the hospital provides public information and education on
child health and injury prevention through the stores. The
hospital
hosts an annual meeting for store representatives to introduce
the programs and materials for the year. "Safety Smart"
targets issues resulting in highest child trauma treatment
costs:
fire, violence, and bicycle safety.
Comments.
This marriage of community-oriented marketing and information
dissemination
contributes to the public service reputation of all parties.
Despite
the title, however, it isn't clear that the program succeeded in
reducing healthcare costs.
B1010.
J.H. Hibbard, J.J. Jewett, M.W. Legnini, and M. Tusler (1997)
Choosing
a health plan: Do large employers use the data? Health Affairs
16(6):172-180.
Comments.
This survey replaces the image of large-scale purchasers being
influenced
by the ever-growing flow of clinical outcome data with an image
of purchasers being influenced largely by the perceptions of the
enrollees, after threshold levels of price and NCQA-indicated
quality
are achieved. Previous studies already document that consumer
satisfaction
is strongly influenced by the availability of wellness promotion
services. If the cost of plans converge, wellness and health
promotion
may indirectly become more important in decisions of corporate
purchasers.
|
