Health is central to our well being. Genetics may predispose us to illness but our lifestyles complete the picture. The University Senate ad hoc committee has been working with the Benefits office and UPMC Health Plan for the past 18 months to improve risk assessment and management programs to address cardiovascular disease and diabetes — two major causes of premature death and decreased quality of life. The committee’s report and its proposal were approved by Faculty Assembly. The proposal was presented to UPMC Health Plan in June and discussions are continuing to determine plans for final implementation.
The “fitness for life” recommendations focus on reducing risk for cardiovascular disease (CVD) and Type II diabetes (TD2). Both CVD and TD2, as well as their complications, are mostly preventable, especially in individuals under the age of 65. Reducing the risks of these illnesses is feasible, can increase active life expectancy and potentially can reduce health care costs. And we can do this. We need to empower the patients — that is, ourselves — to become active participants in our own health and wellness.
We have initiated a patient-specific, confidential, Internet-based program on the Pitt “fitness for life” web page (www.hr.pitt.edu/fitness). Its components include the MyHealth questionnaire, developed by UPMC Health Plan in partnership with WebMD, and the MyHealth record, created by UPMC Health Plan. Central to this effort is the existing periodic screening to identify patients at risk for CVD and TD2. We expect this program to tap into, as well as to extend, existing effective cardiovascular risk reduction and wellness programs.
The committee also recommended specific screening tests, lifestyle modification support and pharmacotherapy options. Periodic blood tests to measure lipid levels and fasting blood sugar already are in place. We recommended that state-of-the-art, non-invasive and fast electron beam computer tomography be a covered benefit for patients with moderate to high risk of heart disease, as it is in some university health plans.
Maximizing adherence to medication therapies after patients with increased risk are identified is a major obstacle to any successful disease prevention program. A major limitation to adherence is cost of the drugs. Another is lack of feedback to the patient about the importance of continued drug therapy, especially if symptoms remit. Remember that high blood pressure is a silent killer.
Importantly, Pitt’s public health, medical and nursing schools have much experience in programs that maximize adherence to medication therapies. One useful approach is the use of health counselors who maintain contact with participants, encourage them to maximize their therapies and reduce the barriers to successful therapies. These barriers could include a lack of transportation to obtain the medications, insufficient advice on side effects and difficulty sticking to a drug regimen.
The remaining goals of the “fitness for life” proposals target education for Pitt faculty and staff and their primary care physician practices. The primary goals of our proposed programs are to develop or augment lifestyle modification initiatives targeting stress reduction, smoking cessation, weight reduction and weight maintenance, increased exercise and, when needed, pharmacologic management of hyperlipidemia, hypertension and diabetes.
Cigarette smoking remains the most significant risk factor for CVD. We recommend that smoking be banned from the University and from all events sponsored by the University. We further recommended that the health plan provide adequate resources to help individuals stop smoking.
Dietary intervention to reduce risk factors is the cornerstone of a successful cardiovascular prevention program but is difficult to accomplish in our food-rich culture. Making healthy choices requires knowledge of what the right choices are as well as the discipline to see those efforts through. Dietary information handed or mailed to patients usually is unsuccessful. We recommended that nutritional programs by certified, qualified nutritionists and behavioral interventionists be a covered benefit. Referral for dietary and behavioral interventions should be coordinated through physician offices within the health plan.
Faculty, staff and their families need to take a proactive role in their own health to both minimize the risk of CVD and TD2 as well as reduce the risk of disease progression once risk is identified. We are the epicenter of our own health and need to realize this. We need to understand at a visceral level that smoking cessation, weight reduction and weight maintenance, stress reduction, proper diet, exercise and, when necessary, pharmacotherapy are the tools needed to create an enduring healthy and joyful life for ourselves and our families.
Together with the Benefits office and UPMC Health Plan we hope to continue to support and improve these risk assessment, management and wellness programs. Our very lives are at stake.
Michael R. Pinsky is a professor of critical care medicine and chair of the Senate’s ad hoc “fitness for life” committee. A list of the ad hoc committee roster and a copy of the proposal is available at the University Senate web site, www.pitt.edu/univsenate/adhoc.html.