USE OF MEDICAL-CARE AFTER A COMMUNITY-BASED HEALTH PROMOTION PROGRAM - A QUASI-EXPERIMENTAL STUDY

Purpose. To assess the effects of health promotion on the use of medic al care services in a community setting. Design. Quasi-experimental, m ultiple time points, case-comparison group. Setting Community health c enter in Ottawa, Canada. Sample. 520 volunteer participants in a healt h promotion program and 932 matched comparison subjects. Intervention. The health promotion program consisted of a weekend workshop on healt h behaviors, lifestyle assessment, and identification of weekly goals for change. This was followed by 18 months of support (5 group session s, weekly telephone calls, and optional individual sessions). Measurem ent, Computerized data on health care use 6 months before, 18 months d uring, and 6 months after the program were obtained from Ontario's uni versal Health Insurance Plan (OHIP). These data were used to determine the number and system costs of visits made by participants and compar isons. Results. When controlling for baseline differences through anal ysis of covariance, program participants were found to have higher cos ts and more visits for ambulatory care during the first year (p < .01) and second year (p < .05) of follow-up. Participants used significant ly more diagnostic services than comparisons during both years of foll ow-up. Participants were also more likely to use more counseling and p sychotherapy services in year 1 (relative with 1.53; 95% confidence in terval, 1.28, 1.81) and year 2 (relative risk 1.57; 95% confidence int erval, 1.31, 1.89. No differences were found between participant and c omparison groups in visits for medical consultations and assessments o r preventive services. Conclusion. No evidence shows that this health promotion program reduced use in this population over the 2-year follo w-up period.