Cardiovascular risk factor screening and follow-up in a military population aged 40 years and older.

OBJECTIVE: This study analyzed a worksite-based cardiovascular risk assessment offered to soldiers aged 40 and older to identify unrecognized cardiovascular risk and evaluate compliance with instructions to follow up for further evaluation. METHODS: Participants had fasting blood tests, waist circumference and blood pressure measurement and a carotid artery duplex scan performed at their worksite. A healthcare professional discussed the participants' results with them and, if indicated, recommended follow up within the following one month. RESULTS: Seventy-six (46%) of the 163 eligible soldiers agreed to participate. Twenty-nine (38%) of the 76 participants were instructed to follow up for elevated blood pressure, glucose, or lipids. Only 7 of 29 (24%) complied with follow-up instructions. CONCLUSION: Voluntary worksite-based interventions can effectively identify soldiers with unmanaged cardiovascular risk factors, but a more aggressive follow-up strategy should be used to ensure these soldiers receive indicated medical intervention.

A novel approach for mental health disease management: the Air Force Medical Service's interdisciplinary model.

Mental health disorders are one of the most substantial public health problems affecting society today, accounting for roughly 15% of the overall burden of disease from all causes in the United States. Although primary care (PC) has the potential to be the frontline for recognition and management of behavioral health conditions, this has been a challenge historically. In order to more effectively address the broad scope of behavioral health needs, the Air Force Medical Service (AFMS) established a new model of behavioral health care. Through a series of coordinated steps, the AFMS ultimately placed trained behavioral health providers into PC clinics to serve as consultants to PC providers (PCPs). Behavioral Health Consultants (BHCs) provide focused assessments, present healthcare options to patients, and deliver brief collaborative interventions in the PC setting. BHCs see patients at the request of the PCP, in 15-30-min appointments. In the pilot study, patients averaged 1.6 visits to the BHC. Over 70% of patients fell into six categories of presenting problems: situational reactions, depressive disorders, adjustment disorders, anxiety disorders, health promotion, and obesity. Patient data (n = 76) suggest 97% of patients seen were either "satisfied" or "very satisfied" with BHC services, and 100% of the PCPs (n = 23, 68% response rate) were highly satisfied and indicated they would "definitely recommend" others use BHC services for their patients. Both the implications and the limitations of this pilot study are discussed.