20082010 Kulin Mehta Dr Terrell W Zollinger Indiana University School of Medicine Department of Public health Public Safety Medical Services Inc STUDY PROTOCOL ID: 779382
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Slide1
Impact of the Public Safety Medical services Wellness program on the health risk factors of the Indianapolis Metropolitan Police Department2008-2010
Kulin Mehta Dr. Terrell W. Zollinger Indiana University School of Medicine, Department of Public health
Public Safety Medical Services Inc.
STUDY PROTOCOL#
1207009097
Slide2IntroductionPolicing is recognized as dangerous, demanding and stressful occupation Police officers face conventional cardiovascular risk factors as well as occupation-specific risksConventional cardiovascular risk factors:ObesityHypertensionDiabetes mellitus/Metabolic syndromeDyslipidemiaSmoking
(Zimmerman, 2012)
Slide3IntroductionOccupation-specific cardiovascular risk factors:Lack of regular exercise (especially in older/retired officers)Poor nutrition (attributed to limited opportunities of healthy food choices while on-duty)Shift work (sleep disruption or deprivation)Noise exposureImbalance between job demands and personal health care discipline Intense physical and mental
stressLife-threatening encounters leading to fatal bodily injuries preceded by stressful bursts of unpredictable emergencies(Kales et al, 2009)
Slide4Purpose of the study This study examines the impact of a wellness program “Public Safety Medical Services(PSMS)” on the health of a cohort of police officers from the Indianapolis Metropolitan Police department (IMPD)
Slide5Public Safety Medical ServicesPremier provider of disease prevention and health promotion services for public safety departments, employer groups, and individuals.Public Safety Medical Services Comprehensive medical screening and fitness testing program for police officersExpert medical & fitness personnel onboardTechnologically advanced medical equipment Laboratory testingClinical consultation and referral, as and when required
Annual follow up and feedback to the IMPD
Slide6Materials & MethodsRetrospective cohort study designSample population includes the IMPD officers enrolled with PSMSInclusion criteria: All police officers who were clinically evaluated by PSMS in 2008 and who have follow-up reports from 2009 and 2010 Exclusion criteria:Any police officer who skipped a year of follow up was excluded from the analysisAny police officer whose baseline evaluation occurred in 2009 or 2010 was excluded from the analysis
Slide7Materials & MethodsCohort size: 382 police officers from IMPDVariables used for data analysis:Height, Weight, birth year, age, race, genderFamily history Systolic & Diastolic blood pressureTotal cholesterol, HDL, LDL and triglyceridesFasting blood glucose Smoking statusIMPD screened at baseline in 2008
Database available for this study from 2008-2010
Slide8Statistical analysisAll statistical analysis performed using SAS v9.2 [PC-SAS by SAS Institute Inc., Cary, NC)Statistical Significance denoted at P< 0.05McNemar’s test used to assess change(proportions) in the health risk factors of IMPD from 2008-2010Proportional differences for each of the health risk factors were tested for statistical significance using the Z test
Slide9Study sample - demographicsAverage age: 43 years M:F : 5:1
Caucasian:
87%African American: 13%
25-34 years: 14%
35-44 years :
45%
45+ years:
41%
Slide10Factor(s) for IMPD officers
Mean
in 2008
Age
43 years
Body Mass Index
28.9
Total Cholesterol
188.0 mg/dl
HDL
49.2 mg/dl
LDL
113.5 mg/dl
Triglycerides
126.0 mg/dl
Blood glucose
93.1 mg/dl
Slide11Obesity (BMI>29.9) 11% improvement
143
131
127
p= 0.2262
Slide12Hypertension [Systolic/Diastolic blood pressure >= 140/90]69% improvementp<0.05
45
16
14
Slide13Borderline risk total cholesterol [200-239 mg/dl]
50% improvementp<0.05 102
52
51
Slide14High risk total cholesterol [>240 mg/dl]37% improvement
p=0.00417
10
Slide15Borderline Risk HDL (41-59 mg/dl)
23% improvement
p= 0.0005
Slide16High risk HDL [<40 mg/dl]
30% improvement
p
= 0.0018
91
64
57
Slide17Borderline Risk LDL (130-159 mg/dl)
58% improvement
p<0.05
Slide18High risk LDL [>160 mg/dl]64% improvement
p=0.0027
28
6
10
Slide19Borderline Risk Triglycerides (150-199 mg/dl)
68% improvementp< 0.05
Slide20High risk triglycerides [>200 mg/dl]51% improvement
p= 0.0041
Slide21Borderline risk blood glucose [100-125 mg/dl]
57% improvementp< 0.05
Slide22High Risk Blood Glucose(>126 mg/dl)8
50% improvement p=0.2460
4
4
Slide23Smoking status38% improvement
p=0.012755
35
33
Slide24Impact of the PSMS programStatistically significant improvement of IMPD for all health risk factors over 2 years of PSMS program intervention exceptObesityHigh risk glucose levelsWith comparable baseline values of IMPD sample with previous studies, PSMS wellness program has been successful in alleviating major cardiovascular risk factors includingHypertension, dyslipidemia, blood glucose levels(borderline risk) and smoking
Slide25LimitationsSmall sample sizeSelection bias Missing values Data available is for a shorter length of the cohort studyBias due to self reporting at baseline (eg. smoking data)Inaccuracy of data entered by officers into the Motivation survey databaseNon-compliance and lost to follow up
Slide26Recommendations Data quality check at regular intervalsMissing entries in the database to be cross verified for accuracyData verification system should be installed in the program to check for human error that could occur on the part of IMPD officers while entering data into their systemCase-specific modification of the wellness protocol from annual to bi-annual(or more) follow up of high risk public safety personnel Feedback loop following physician referrals
Slide27ConclusionWithout a wellness program, baseline data for IMPD officers is suggestive of increased cardiovascular risk which is of concern given the added stress from the occupationThe PSMS intervention has brought about statistically significant improvement in the clinical profiles of the IMPD officersProspectively improving trends in the health status of the police officers following PSMS intervention- long term gain both in health, quality of life and work efficiency
Slide28ConclusionBesides clinical intervention, PSMS program has led to a behavioral impact on the IMPD officers as noted by the statistical significant drop in their smoking status over 2 yearsThis study supports the idea of a wellness program like PSMS to be accepted on a wider scale by most public safety departments that have job-specific risk factors in addition to the traditional cardiovascular risks faced by the general population
Slide29Dr. Steven Moffatt, Medical Director, Public Safety Medical Services Inc.Nelson Hale, Director of IT, Public Safety Medical Services Inc. Alex
Lopes, Manager of Market Analysis and Strategic Planning, Public Safety Medical Services Inc. Dr. Robert Saywell,
Professor Emeritus and Senior Investigator, Bowen Research Center, Indiana University School of Medicine
Dr. Terrell
Zollinger
,
Professor, Department of Public
Health, Indiana University School of Medicine
Acknowledgement
Slide30THANK YOU For questions email: kulinkmehta@gmail.com
Slide31ReferencesFranke W, Ramey S and Shelley M (2002). Relationship between cardiovascular disease morbidity, risk factors, and stress in law enforcement cohort. Journal Of Occupational and Environmental Medicine 2002; 44: 1182-1189Kales Stefanos, Tsismenakis
Antonios, Zhang Chunbai and Soteriades Elpidoforos (2009). Blood pressure in firefighters, Police officers, and other emergency responders.
American Journal of Hypertension 2009 Jan; 22(1): 11-20 Perrin
M.A,
DiGrande
L, Wheeler K, Thorpe L, Farfel M,
Brackbill
R (2007). Differences in
PTSD
Prevalence and Associated Risk Factors Among World Trade Center Disaster
Rescue
and Recovery Workers.
American Journal of Psychiatry
2007;164:1385- 1394
.
doi
:
10.1176/appi.ajp.2007.06101645
Public Safety Medical Services Inc. (2012). Retrieved from
www.publicsafetymed.com
on June 15, 2012
Ramey Sandra, Downing Nancy and
Franke
Warren (2009). Milwaukee Police Department
Retirees
– Cardiovascular Disease Risk and Morbidity Among Aging Law Enforcement
Officers
. American Association of Occupational Health Nurses
. 2009 v57 n11 (20091101):
448-453
U.S Bureau of Labor Statistics (May 2010). Retrieved from
http://www.bls.gov
on June 15, 2012
Zimmerman
Franklin (2012). Cardiovascular Disease and Risk Factors in Law Enforcement
Personnel
: A Comprehensive Review.
Cardiology in Review
2012;20:
159–166