Evaluating a web-based self-management program for employees with hypertension and prehypertension: A randomized clinical trial

摘要

Background: Web-based self-management programs offer a novel approach for self-insured employers seeking to improve and maintain employee health. Methods: We conducted a 6-month prospective, cluster-randomized controlled trial designed to evaluate whether worksite access to an automated, web-based, self-management program resulted in better blood pressure control. The trial was conducted at 6 EMC Corporation worksites in Massachusetts, each of which had at least 600 employees; 404 EMC employees with pre-hypertension or hypertension participated. Participants at 3 worksites received a home blood pressure cuff that uploaded readings to a Web site where they could view trends and read automated rules-based messages. Participants at 3 worksites received access to an onsite blood pressure cuff. Primary outcome measure was change in systolic blood pressure. Secondary outcome measures were change in diastolic blood pressure, proportion of participants achieving significant changes in systolic and diastolic blood pressure, and subject satisfaction. Results: Although the mean change in systolic blood pressure was not significantly different between intervention and control groups (-1.69 vs. -0.86 mm HG, respectively, P =.49) the change in diastolic blood pressure between groups was significant. (-1.08 vs. = 1.47 mm HG, respectively, P <.001). Significantly more intervention participants experienced a >10-mm Hg decrease in systolic blood pressure or >5-mm Hg decrease in diastolic blood pressure compared to controls (22% vs 17%, P =.02 and 29% vs 16%, P =.03, respectively). Intervention participants were twice as likely to report starting a new medication (P =.02) and more likely to report improved communication with their doctor (P =.02). Conclusions: Participation in an automated online self-management program resulted in improved blood pressure among employees with prehypertension or hypertension.