A look at how companies are addressing chronic disease through proactive screening

With diabetes becoming more prevalent in Canada, Quebec-based Laurentide Controls Ltd. is among employers taking action by launching screening programs for the disease.

Recently, the company participated in AstraZeneca Canada Inc.’s diabetes screening program called Motivaction. Based on the results of a confidential online survey for diabetes risk, employees who score as medium to high risk can undergo biometric screening and receive counselling from a registered nurse at their work site. The program — a six-month pilot available for employers to participate in for free — also includes surveys around mental health and quality of life. Those with a confirmed diagnosis of diabetes or blood glucose levels putting them at high risk of developing the disease can receive coaching by a certified diabetes educator.

According to Andrea Croft, customer service manager at Laurentide Controls, 100 of the 285 employees invited to complete the online screening form participated in the program. Of the 23 employees invited for on-site screening, 14 attended, seven of whom were eligible to continue for the full term of the program. The company completed its second on-site screening in April.

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Croft sees the program’s value if it can change or help just one employee. “If only one person became aware of their situation, it’s a great success,” she says. “I just need one, because it’s somebody’s life.”

That awareness is key, she adds, as some employees may think they’re healthy but really aren’t. Unless they know someone who has diabetes, they’re not going to be aware of the symptoms or what to do, she says. “If you’re not in that world — and you’re 25 years old — it’s not something in the forefront.”

Help from employers

In 2015, diabetes affected an estimated nine per cent of Canada’s population, according to a report from the Canadian Diabetes Association.

For many employers, pre-diabetic and diabetic employees can have a big impact on the workplace: more absences, less productivity and more disability claims. “As a physician, I feel we have to do something,” says Dr. Alain Sotto, occupational medical consultant for the Toronto Transit Commission. “We have to do the responsible thing.”

According to Sotto, the workplace is the perfect place for diabetes screening because employees are “hungry for this information. They’re starving for [it].”
He points to the 2015 Sanofi Canada health-care survey. When the survey asked plan members to choose from a list of possible new health-related benefits offerings, 45 per cent chose on-site screening with a health-care professional to determine their risk for certain diseases.

Read: Employees tell their stories of working with chronic diseases

In late 2015, the TTC also implemented a diabetes screening program in partnership with the Health Team, a company that provides health and wellness programs to employers. Similar to Motivaction, it included biometric screenings, consultation with a healthcare professional and an assessment of each participant’s cardiovascular risk. The program saw voluntary participation by about 1,000 employees.

But should diabetes screening programs be mandatory, particularly for jobs that involve more sedentary work? Employers can’t mandate those kinds of programs, says Sotto, because they then become a condition of employment. “You have to wear safety shoes but you don’t have to have your blood sugar measured, for instance.”

Sotto, who reviews all of the disability management files for the TTC, says it’s not just necessarily the disease itself that causes people to go on leave. “It’s not people who go off with diabetes,” he says. “They go off with the complications of diabetes. We realized from our drug utilization data that people were becoming more diabetic, more pre-diabetic and [used more] cardiac drugs.”

Return on investment

Peter Gove, innovation leader for health management at Green Shield Canada, says that while many employers have an interest in doing health promotion for their employees, the challenge with a program like diabetes screening is demonstrating the return on investment. “The outcomes are long term, and a lot of the ROI accrues to public health, rather than through the employer,” he says.

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Still, return on investment is simply one measure, he says. “It’s important to capture if you can, but you have to think about the other value of doing these kinds of programs: societal and organizational.”

Croft agrees, adding that by implementing such programs, employers can demonstrate their engagement with employees. “Employers are saying that this is really important to us, so we’re going to launch this program. Your health matters. You matter. Let’s take the time to do this.”

Rethinking the benefits plan

A diabetes screening program does, however, come at a cost, says Gove. But if employers began to rethink their benefits plans, such programs wouldn’t be cost-prohibitive, he suggests.

“When we look at the kinds of things that benefits plans fund, we often question the value of them in terms of real health benefits, health promotion. We really need to think seriously about what we’re trying to do with these plans. If they’re about supporting health, then we should be looking at programs like this one.”

Green Shield’s year-long health study bears that out. It found its clients spent about $144 million on benefits such as glasses, orthotic shoes and massage and chiropractic services in 2014. However, only $100,000 of that amount was for registered dietitians and nutritionists.

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Sotto has a similar concern. “What do employers want from their benefits plan? Do they want to provide massages or diabetes services with diabetes education or pre-diabetes education?” he asks.

“You’re not healthier because you go for a massage; you’re not healthier because you go to chiro,” he adds. “That’s not going to change your morbidity and outcome to chronic diseases such as hypertension, diabetes and stroke. I’ve never known a person to die from not getting a massage.”

Brooke Smith is a freelance writer and editor based in Toronto.

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