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BACKGROUND: Cardiovascular disease remains the leading cause of death in America and poses a significant challenge for self-insured employers attempting to improve employee health and well-being while controlling healthcare costs. Disease state management programs can be an effective means of achieving these outcomes, but the durability and long-term effects of such programs have limited evaluation. OBJECTIVE: To assess the 5-year health, economic, and quality-of-life patient outcomes of an employer-sponsored disease state management program. METHODS: This was a longitudinal, 5-year, quasi-experimental, pre-/postenrollment study. Self-insured health plan members with hypertension, hyperlipidemia, diabetes, or a combination of these conditions met with a pharmacist regularly (monthly for the first year, then varied by participant) to implement lifestyle medicine programs, optimize medication therapy, and facilitate the coordination of care. Biometric markers, lifestyle behaviors, quality of life, and work productivity were assessed on an annual basis. RESULTS: The significant biometric improvements (mean) seen after 5 years of program participation compared with pre-enrollment included decreased low-density lipoprotein cholesterol levels (96.71 mg/dL vs 84.83 mg/dL, respectively), increased high-density lipoprotein cholesterol levels (39.32 mg/dL vs 46.12 mg/dL), and decreased systolic blood pressure (132.04 mm Hg vs 123.63 mm Hg) and diastolic blood pressure (85.75 mm Hg vs 75.83 mm Hg). The average exercise time increased (50 minutes weekly vs 156.04 minutes weekly), as did fruit and vegetable consumption (3.98 servings daily vs 5.27 servings daily). The program participants reported improved general health and a reduced number of unhealthy days. The combined healthcare and productivity return on investment for the program at 5 years was $9.64 for every $1 invested. CONCLUSIONS: Significant changes in employees' health, well-being, and health-related costs are possible through sustained participation in an employer-sponsored disease state management program.

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OBJECTIVE: To examine the use of various cardiovascular disease (CVD) risk estimation calculators in pharmacy practice. DESIGN: Longitudinal cohort study. SETTING: Midwestern university worksite from August 2008 through May 2012. PARTICIPANTS: University employees with hypertension, dyslipidemia, and diabetes. INTERVENTION: Risk estimation calculators were applied to data from a pharmacist-run chronic disease management program. MAIN OUTCOME MEASURE: Difference in estimated CVD risk from multiple estimation calculators. RESULTS: At baseline and 12 months, non-lab-based tools reported significantly higher 10-year CVD risk percentages compared with lab-based tools among the same cohort of patients (10.63% vs. 8.71% at baseline, P < 0.001; 9.34% vs. 7.31% at 12 months, P < 0.001). In addition, the electronic version of 10-year CVD risk reported significantly higher values than the paper version when applied to the same patient cohort (7.31% vs. 6.60% at 12 months, P = 0.018). CONCLUSION: CVD risk estimation tools report significantly different values and are not interchangeable. Pharmacists using non-lab-based tools should expect significantly higher risk estimates than estimates derived from lab-based tools and therefore should use the same version of the estimation tool over the long term.

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An important component to optimal health is quality of life (QOL). Several healthy lifestyle behaviors have independently shown to improve QOL. The simultaneous implementation of multiple lifestyle behaviors is thought to be difficult, and the current literature lacks the assessment of multiple lifestyle behaviors simultaneously with respect to the effect on QOL. This current pilot study sought to develop a method to quantify multiple lifestyle behaviors into a single index value. This value was then measured with QOL for a possible correlation. The results showed that it is possible to convert multiple raw healthy lifestyle data points into a composite value and that an improvement in this value correlates to an improved QOL. After 12 months of participation in a cardiovascular risk reduction program, study participants (N = 35) demonstrated a 37.4% (P < 0.001) improvement in the composite lifestyle index (CLI). The improved CLI demonstrated a correlation with a statistically significant improvement in how participants rated their overall health in 12 months (r = 0.701, P < 0.001) as well as the number of self-reported unhealthy days per month in 12 months (r = -0.480, P = 0.004).

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A recent increase in the incidence of diabetes and pre-diabetes is causing many employers to spend more of their healthcare benefit budgets to manage the conditions. A self-insured university in the USA has implemented an interprofessional diabetes mellitus risk reduction program using its own employee faculty and staff experts to help fellow employees manage their diabetes and pre-diabetes. The interprofessional team consists of five pharmacists, a dietitian, an exercise physiologist, a health educator and a licensed mental health practitioner. In addition, the participant's physician serves as a consultant to the program, as does a human resources healthcare benefits specialist and a wellness coordinator. The volunteer program takes place at the worksite during regular business hours and is free of charge to the employees. The faculty and staff delivering the program justify the cost of their time through an interprofessional educational model that the program will soon provide to university students.

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