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Public Safety Medical Services Inc.

Impact of the Public Safety Medical services Wellness program on the health risk factors of the Indianapolis Metropolitan Police Department 2008-2010. STUDY PROTOCOL# 1207009097.

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Public Safety Medical Services Inc.

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  1. Impact of the Public Safety Medical services Wellness program on the health risk factors of the Indianapolis Metropolitan Police Department2008-2010 STUDY PROTOCOL#1207009097 Kulin Mehta Dr. Terrell W. ZollingerIndiana University School of Medicine, Department of Public health Public Safety Medical Services Inc.

  2. Introduction • Policing is recognized as dangerous, demanding and stressful occupation • Police officers face conventional cardiovascular risk factors as well as occupation-specific risks • Conventional cardiovascular risk factors: • Obesity • Hypertension • Diabetes mellitus/Metabolic syndrome • Dyslipidemia • Smoking (Zimmerman, 2012)

  3. Introduction • Occupation-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 exposure • Imbalance between job demands and personal health care discipline • Intense physical and mental stress • Life-threatening encounters leading to fatal bodily injuries preceded by stressful bursts of unpredictable emergencies (Kales et al, 2009)

  4. Purpose 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)

  5. Public Safety Medical Services • Premier 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 officers • Expert medical & fitness personnel onboard • Technologically advanced medical equipment • Laboratory testing • Clinical consultation and referral, as and when required • Annual follow up and feedback to the IMPD

  6. Materials & Methods • Retrospective cohort study design • Sample population includes the IMPD officers enrolled with PSMS • Inclusion 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 analysis • Any police officer whose baseline evaluation occurred in 2009 or 2010 was excluded from the analysis

  7. Materials & Methods • Cohort size: 382 police officers from IMPD • Variables used for data analysis: • Height, Weight, birth year, age, race, gender • Family history • Systolic & Diastolic blood pressure • Total cholesterol, HDL, LDL and triglycerides • Fasting blood glucose • Smoking status • IMPD screened at baseline in 2008 • Database available for this study from 2008-2010

  8. Statistical analysis • All statistical analysis performed using SAS v9.2 [PC-SAS by SAS Institute Inc., Cary, NC) • Statistical Significance denoted at P< 0.05 • McNemar’s test used to assess change(proportions) in the health risk factors of IMPD from 2008-2010 • Proportional differences for each of the health risk factors were tested for statistical significance using the Z test

  9. Study sample - demographics Average age: 43 years M:F : 5:1 Caucasian: 87% African American: 13% 25-34 years: 14% 35-44 years : 45% 45+ years: 41%

  10. Obesity (BMI>29.9)  11% improvement p= 0.2262 143 131 127

  11. Hypertension [Systolic/Diastolic blood pressure >= 140/90] • 69% improvement • p<0.05 45 14 16

  12. Borderline risk total cholesterol [200-239 mg/dl] • 50% improvement • p<0.05 102 51 52

  13. High risk total cholesterol [>240 mg/dl] • 37% improvement • p=0.0041 7 10

  14. Borderline Risk HDL (41-59 mg/dl) • 23% improvement • p= 0.0005

  15. High risk HDL [<40 mg/dl] • 30% improvement • p= 0.0018 91 64 57

  16. Borderline Risk LDL (130-159 mg/dl) • 58% improvement • p<0.05

  17. High risk LDL [>160 mg/dl] • 64% improvement • p=0.0027 28 6 10

  18. Borderline Risk Triglycerides (150-199 mg/dl) • 68% improvement • p< 0.05

  19. High risk triglycerides [>200 mg/dl] • 51% improvement • p= 0.0041

  20. Borderline risk blood glucose [100-125 mg/dl] • 57% improvement • p< 0.05

  21. High Risk Blood Glucose(>126 mg/dl) • 50% improvement • p=0.2460 4 4 8

  22. Smoking status • 38% improvement • p=0.0127 55 35 33

  23. Impact of the PSMS program • Statistically significant improvement of IMPD for all health risk factors over 2 years of PSMS program intervention except • Obesity • High risk glucose levels • With comparable baseline values of IMPD sample with previous studies, PSMS wellness program has been successful in alleviating major cardiovascular risk factors including • Hypertension, dyslipidemia, blood glucose levels(borderline risk) and smoking

  24. Limitations • Small sample size • Selection bias • Missing values • Data available is for a shorter length of the cohort study • Bias due to self reporting at baseline (eg. smoking data) • Inaccuracy of data entered by officers into the Motivation survey database • Non-compliance and lost to follow up

  25. Recommendations • Data quality check at regular intervals • Missing entries in the database to be cross verified for accuracy • Data 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 system • Case-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

  26. Conclusion • Without a wellness program, baseline data for IMPD officers is suggestive of increased cardiovascular risk which is of concern given the added stress from the occupation • The PSMS intervention has brought about statistically significant improvement in the clinical profiles of the IMPD officers • Prospectively 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

  27. Conclusion • Besides 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 years • This 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

  28. Acknowledgement Dr. 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

  29. THANK YOU For questions email: kulinkmehta@gmail.com

  30. References • Franke 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: 1182-1189 • Kales Stefanos, TsismenakisAntonios, Zhang Chunbai and SoteriadesElpidoforos (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

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