The impact of a health education program targeting patients with high visit rates in a managed care organization.
OBJECTIVE
To determine if a mailed health promotion program reduced outpatient visits while improving health status.


METHODS
Randomized controlled trial.


METHODS
A midsized, group practice model, managed care organization in Ohio.


METHODS
Members invited (N = 3214) were high utilizers, 18 to 64 years old, with hypertension, diabetes, or arthritis (or all). A total of 886 members agreed to participate, and 593 members returned the initial questionnaires. The 593 members were randomized to the following groups: 99 into arthritis treatment and 100 into arthritis control, 94 into blood pressure treatment and 92 into blood pressure control, and 104 into diabetes treatment and 104 into diabetes control.


METHODS
Outpatient utilization, health status, and self-efficacy were followed over 30 months.


METHODS
Health risk appraisal questionnaires were mailed to treatment and control groups before randomization and at 1 year. The treatment group received three additional condition-specific (arthritis, diabetes, or hypertension) questionnaires and a health information handbook. The treatment group also received written health education materials and an individualized feedback letter after each returned questionnaire. The control group received condition-specific written health education materials and reimbursement for exercise equipment or fitness club membership after returning the 1-year end of the study questionnaire.


RESULTS
Changes in visit rates were disease specific. Parameter estimates were calculated from a Poisson regression model. For intervention vs. controls, the arthritis group decreased visits 4.84 per 30 months (p < 0.00), the diabetes group had no significant change, and the hypertension group increased visits 2.89 per 30 months (p < 0.05), the overall health status improved significantly (-6.5 vs. 2.3, p < 0.01) for the arthritis group but showed no significant change for the other two groups, and coronary artery disease and cancer risk scores did not change significantly for any group individually. Overall self-efficacy for intervention group completers improved by -8.6 points (p < 0.03) for the arthritis group, and the other groups showed no significant change.


CONCLUSIONS
This study demonstrated that in a population of 18 to 64 years with chronic conditions, mailed health promotion programs might only benefit people with certain conditions.
Dally
Diana L
DL
Kaiser Foundation Health Plan of Ohio, 5410 Lancaster Boulevard, Brooklyn Heights, OH 44131, USA.
Dahar
Wendy
W
Scott
Ann
A
Roblin
Douglas
D
Khoury
Allan T
AT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001168:Arthritis / Q000628:therapy; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D006266:Health Education / Q000379:methods / Q000458:organization & administration*; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D009820:Ohio; D015397:Program Evaluation; D012648:Self Care; D020377:Self Efficacy; D011795:Surveys and Questionnaires