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 medical care services in a community setting. Design. Quasi-experimental, multiple time points, case-comparison group. Setting. Community health center in Ottawa, Canada. Sample. 520 volunteer participants in a health promotion program and 932 matched comparison subjects. Intervention. The health promotion program consisted of a weekend workshop on health behaviors, lifestyle assessment, and identification of weekly goals for change. This was followed by 18 months of support (5 group sessions, weekly telephone calls, and optional individual sessions). Measurement. Computerized data on health care use 6 months before, 18 months during, and 6 months after the program were obtained from Ontario's universal Health Insurance Plan (OHIP). These data were used to determine the number and system costs of visits made by participants and comparisons. Results. When controlling for baseline differences through analysis of covariance, program participants were found to have higher costs and more visits for ambulatory care during the first year ( p < .01) and second year (p <.05) of follow-up. Participants used significantly more diagnostic services than comparisons during both years of follow-up. Participants were also more likely to use more counseling and psychotherapy services in year 1 (relative risk, 1.53; 95% confidence interval, 1.28, 1.81) and year 2 (relative risk, 1.57; 95% confidence interval, 1.31, 1.89). No differences were found between participant and comparison groups in visits for medical consultations and assessments or preventive services. Conclusion. No evidence shows that this health promotion program reduced use in this population over the 2-year follow-up period.