Impact of Primary Care Worksite Health and Wellness Clinics on HbA1c Level Among Prediabetic or Diabetic Employees

Published in: American Journal of Health Promotion (2020). doi: 10.1177/0890117120927307

Posted on RAND.org on December 10, 2020

by Catherine C. Cohen, Simon Hollands, Harry H. Liu

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Purpose

To determine whether the use of worksite health and wellness clinics reduced hemoglobin A1c (HbA1c) for prediabetic and diabetic employees.

Design

Hemoglobin A1c values were compared between clinic users and matched non-users.

Setting

The Wonderful Company's (TWC's) agricultural and packaging sites in Central California.

Sample

TWC's 2016 to 2017 employees who used clinics (n = 445, defined below) and clinic non-users (n = 217) who had HbA1c screening and worked at TWC for 3 or more months each year.

Intervention

A unique worksite health and wellness clinic that offers multidisciplinary primary medical care in synergy with TWC's overall wellness programs.

Measures

Exposure was clinic use, defined by frequency and patterns of visits. Hemoglobin A1c was the outcome of interest.

Analysis

Users and non-users were propensity score matched using the 2016 employee data including HbA1c, and then 2017 HbA1c values were compared between the 2 groups.

Results

The 2017 HbA1c of diabetic employees was lower among clinic users compared to non-users (7.42 vs 8.53, P < .001). Differences in HbA1c among prediabetics or diabetics and prediabetics aggregated were not statistically significant, despite TWC's population-level data showing a reduction in prediabetes prevalence. The clinic impact results were robust to multivariate analyses and an alternative definition of utilization.

Conclusion

The implementation of TWC's Health and Wellness clinics was associated with reductions in HbA1c among diabetics, but further research is needed on prediabetics.

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