A comparative economic analysis of work-related hypertension care programs.

Cost of care and blood pressure control achieved were examined for individuals enrolled in two worksite hypertension control programs. In the first program, care was provided in a community-based setting by private physicians (model I-CBC); in the second program care was rendered by nurses under the supervision of a physician in work-based clinics (model II-WBC). In both situations, however, identification of employees with hypertension was effected through screening at the worksite. After adjustment for differences in labor market costs, annual average costs per client were found to be comparable for both programs. Blood pressure control (less than 160/95 mm Hg) was greater in model II-WBC than in model I-CBC. The average cost per unit of blood pressure reduction achieved by model II-WBC was +8.25 compared with +28.84 for model I-CBC, indicating a greater cost-effectiveness for worksite care programs.

Occupationally-sponsored, community-provided hypertension control.

A hypertension control program established by the Massachusetts Mutual Life Insurance Company in 1977 included education, on-site case finding, and referral to community physicians with a company-based follow-up system facilitated by assumption of all costs by the company. Ninety-eight percent (2, 463) of the employees were screened; 11% (277) had hypertension. Of these, 59% were in treatment and 36% were controlled at entry. More than 84% of the hypertensives accepted referral to care and 79% fulfilled all program requirements. By the fifth program years, 70% had achieved blood pressure control. Mean blood pressure declined from 150/93 to 142/88 mm Hg. Absenteeism for all hypertensives averaged 4.7 in the three years before and 5.7 during the four years of the program. Employees active in the program had fewer average days of absenteeism (4.7) than inactive participants (6.8). Modest cost and a favorable employee/physician response has made this a highly acceptable as well as an effective company health program.

A company-instituted program to improve blood pressure control in primary care.

An occupation-based effort to improve the outcome of antihypertensive therapy provided in the community was instituted by the Massachusetts Mutual Life Insurance Company in 1977. The goal of the program was to utilize the administrative and organizational resources of the company to enhance employee/patient adherence to treatment provided in conventional primary care settings. Key elements of the program were: companywide education and on-site screening, referral to community physicians and company assumption of all patient costs, linked to a monitoring system to permit oversight of care. Initially, 98% of employees were screened, 70% accepted referral for care and 59% fully adhered to program performance criteria. Blood pressure control has risen from 36% at the beginning to 69% at the end of the second year. Fully compliant patients have achieved the greatest lowering of blood pressure and compiled the best work attendance record. Program costs are modest and acceptance by employees and physicians supports the concept that occupation-based, systematic efforts can enhance the impact of primary care.