Rethinking cardiovascular screening: an observational study of workplace wellness kiosks

The problem

High blood pressure is a major risk factor for cardiovascular disease. Opportunistic screening of blood pressure in primary care is currently not able to achieve universal coverage, and can intrude into limited patient contact time. Out-of-office kiosks, incorporating blood pressure and weight measurement as well as lifestyle advice offer an innovative means to identify individuals with high cardiovascular risk. We carried out an retrospective observational study of an interactive workplace wellness kiosk (Wellpoint), to assess usage, and its potential as an intervention to reduce blood pressure.

The approach

We conducted a retrospective analysis of data from a single UK employer, with kiosks installed in six workplaces. Pseudonymised data collected from January 2013 to May 2014 was supplied by the kiosk manufacturer. This data included 34,662 blood pressure measurements from 9,562 unique users, of whom 3,998 made repeated measurements. We carried out paired t-tests on the data from employees with repeat blood pressure measurements approximately 6 or 12 months after their baseline measurement, to identify changes in blood pressure over this period.

Findings

In 955 employees with measurements between 5 and 7 months after their baseline measure, blood pressure dropped by 6.02/2.78 mmHg (95% CI 5.10/2.09 to 6.94/3.47 mmHg, p<0.0001). We also identified 676 employees with repeat measurements between 10 and 14 months from baseline. These experienced a drop in blood pressure of 5.80/2.83 mmHg (95% CI 4.68/1.97 to 6.92/3.69 mmHg, p<0.0001). There was no significant change in blood pressure between 6 and 12 months from baseline in 368 employees with measurements at both time points. Subgroup analysis by site did not show any significant difference in blood pressure changes between sites.

Consequences

These results show that there is a small but clinically and statistically significant reduction in blood pressure in users of a workplace kiosk, which is sustained at 6 and 12 months. Population-level changes in blood pressure of this magnitude are likely to result in considerable decreases in overall cardiovascular risk. The mechanisms causing decreases in blood pressure in individuals using a workplace wellness kiosk are currently unclear, but may include motivation to carry out lifestyle changes or access primary care following advice from the kiosk. Since there is no comparison group, it is not possible to rule out regression to the mean as an explanation for the decrease in blood pressure, and so further research in the form of a randomised controlled trial is planned. Workplace kiosks may offer an opportunity to think differently about cardiovascular screening and monitoring in the workforce, as well as providing a route to disseminate lifestyle advice.

Credits

• Susannah Fleming
• Richard McManus
• Carl Heneghan
• Alison Ward