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Christoffersen NB, Nilou FE, Thilsing T, Larsen LB, Østergaard JN, Broholm-Jørgensen M. Exploring targeted preventive health check interventions - a realist synthesis. BMC Public Health 2023; 23:1928. [PMID: 37798691 PMCID: PMC10557298 DOI: 10.1186/s12889-023-16861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Preventive health checks are assumed to reduce the risk of the development of cardio-metabolic disease in the long term. Although no solid evidence of effect is shown on health checks targeting the general population, studies suggest positive effects if health checks target people or groups identified at risk of disease. The aim of this study is to explore why and how targeted preventive health checks work, for whom they work, and under which circumstances they can be expected to work. METHODS The study is designed as a realist synthesis that consists of four phases, each including collection and analysis of empirical data: 1) Literature search of systematic reviews and meta-analysis, 2) Interviews with key-stakeholders, 3) Literature search of qualitative studies and grey literature, and 4) Workshops with key stakeholders and end-users. Through the iterative analysis we identified the interrelationship between contexts, mechanisms, and outcomes to develop a program theory encompassing hypotheses about targeted preventive health checks. RESULTS Based on an iterative analysis of the data material, we developed a final program theory consisting of seven themes; Target group; Recruitment and participation; The encounter between professional and participants; Follow-up activities; Implementation and operation; Shared understanding of the intervention; and Unintended side effects. Overall, the data material showed that targeted preventive health checks need to be accessible, recognizable, and relevant for the participants' everyday lives as well as meaningful to the professionals involved. The results showed that identifying a target group, that both benefit from attending and have the resources to participate pose a challenge for targeted preventive health check interventions. This challenge illustrates the importance of designing the recruitment and intervention activities according to the target groups particular life situation. CONCLUSION The results indicate that a one-size-fits-all model of targeted preventive health checks should be abandoned, and that intervention activities and implementation depend on for whom and under which circumstances the intervention is initiated. Based on the results we suggest that future initiatives conduct thorough needs assessment as the basis for decisions about where and how the preventive health checks are implemented.
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Affiliation(s)
- Nanna Bjørnbak Christoffersen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Freja Ekstrøm Nilou
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, University of Southern, Odense, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, University of Southern, Odense, Denmark
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | | | - Marie Broholm-Jørgensen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Duddy C, Gadsby E, Hibberd V, Krska J, Wong G. What happens after an NHS Health Check? A survey and realist review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-133. [PMID: 37830173 DOI: 10.3310/rgth4127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Background The National Health Service Health Check in England aims to provide adults aged 40 to 74 with an assessment of their risk of developing cardiovascular disease and to offer advice to help manage and reduce this risk. The programme is commissioned by local authorities and delivered by a range of providers in different settings, although primarily in general practices. This project focused on variation in the advice, onward referrals and prescriptions offered to attendees following their health check. Objectives (1) Map recent programme delivery across England via a survey of local authorities; (2) conduct a realist review to enable understanding of how the National Health Service Health Check programme works in different settings, for different groups; (3) provide recommendations to improve delivery. Design Survey of local authorities and realist review of the literature. Review methods Realist review is a theory-driven, interpretive approach to evidence synthesis that seeks to explain why, when and for whom outcomes occur. We gathered published research and grey literature (including local evaluation documents and conference materials) via searching and supplementary methods. Extracted data were synthesised using a realist logic of analysis to develop an understanding of important contexts that affect the delivery of National Health Service Health Checks, and underlying mechanisms that produce outcomes related to our project focus. Results Our findings highlight the variation in National Health Service Health Check delivery models across England. Commissioners, providers and attendees understand the programme's purpose in different ways. When understood primarily as an opportunity to screen for disease, responsibility for delivery and outcomes rests with primary care, and there is an emphasis on volume of checks delivered, gathering essential data and communicating risk. When understood as an opportunity to prompt and support behaviour change, more emphasis is placed on delivery of advice and referrals to 'lifestyle services'. Practical constraints limit what can be delivered within the programme's remit. Public health funding restricts delivery options and links with onward services, while providers may struggle to deliver effective checks when faced with competing priorities. Attendees' responses to the programme are affected by features of delivery models and the constraints they face within their own lives. Limitations Survey response rate lower than anticipated; review findings limited by the availability and quality of the literature. Conclusions and implications The purpose and remit of the National Health Service Health Check programme should be clarified, considering prevailing attitudes about its value (especially among providers) and what can be delivered within existing resources. Some variation in delivery is likely to be appropriate to meet local population needs, but lack of clarity for the programme contributes to a 'postcode lottery' effect in the support offered to attendees after a check. Our findings raise important questions about whether the programme itself and services that it may feed into are adequately resourced to achieve positive outcomes for attendees, and whether current delivery models may produce inequitable outcomes. Future work Policy-makers and commissioners should consider the implications of the findings of this project; future research should address the relative scarcity of studies focused on the end of the National Health Service Health Check pathway. Study registration PROSPERO registration CRD42020163822. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR129209).
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Affiliation(s)
- Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Erica Gadsby
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Vivienne Hibberd
- Public Involvement in Pharmacy Studies Group, Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham Maritime, UK
| | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham Maritime, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Debiec R, Lawday D, Bountziouka V, Beeston E, Greengrass C, Bramley R, Sehmi S, Kharodia S, Newton M, Marshall A, Krzeminski A, Zafar A, Chahal A, Heer A, Khunti K, Joshi N, Lakhani M, Farooqi A, Patel R, Samani NJ. Evaluating the clinical effectiveness of the NHS Health Check programme: a prospective analysis in the Genetics and Vascular Health Check (GENVASC) study. BMJ Open 2023; 13:e068025. [PMID: 37253489 PMCID: PMC10230936 DOI: 10.1136/bmjopen-2022-068025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/18/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The aim of the study was to assess the clinical effectiveness of the national cardiovascular disease (CVD) prevention programme-National Health Service Health Check (NHSHC) in reduction of CVD risk. DESIGN Prospective cohort study. SETTING 147 primary care practices in Leicestershire and Northamptonshire in England, UK. PARTICIPANTS 27 888 individuals undergoing NHSHC with a minimum of 18 months of follow-up data. OUTCOME MEASURES The primary outcomes were NHSHC attributed detection of CVD risk factors, prescription of medications, changes in values of individual risk factors and frequency of follow-up. RESULTS At recruitment, 18% of participants had high CVD risk (10%-20% 10-year risk) and 4% very high CVD risk (>20% 10-year risk). New diagnoses or hypertension (HTN) was made in 2.3% participants, hypercholesterolaemia in 0.25% and diabetes mellitus in 0.9%. New prescription of stains and antihypertensive medications was observed in 5.4% and 5.4% of participants, respectively. Total cholesterol was decreased on average by 0.38 mmol/L (95% CI -0.34 to -0.41) and 1.71 mmol/L (-1.48 to -1.94) in patients with initial cholesterol >5 mmol/L and >7.5 mmol/L, respectively. Systolic blood pressure was decreased on average by 2.9 mm Hg (-2.3 to -3.7), 15.7 mm Hg (-14.1 to -17.5) and 33.4 mm Hg (-29.4 to -37.7), in patients with grade 1, 2 and 3 HTN, respectively. About one out of three patients with increased CVD risk had no record of follow-up or treatment. CONCLUSIONS Majority of patients identified with increased CVD risk through the NHSHC were followed up and received effective clinical interventions. However, one-third of high CVD risk patients had no follow-up and therefore did not receive any treatment. Our study highlights areas of focus which could improve the effectiveness of the programme. TRIAL REGISTRATION NUMBER NCT04417387.
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Affiliation(s)
- Radoslaw Debiec
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Daniel Lawday
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Vasiliki Bountziouka
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
- Department of Food Science and Nutrition, University of the Aegean, Lemnos, Greece
| | - Emma Beeston
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Chris Greengrass
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Richard Bramley
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Sue Sehmi
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Shireen Kharodia
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Michelle Newton
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Andrea Marshall
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | | | - Azhar Zafar
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes and Cardiovascular Medicine General Practice Alliance Federation Research and Training Academy, Northampton, UK
| | - Anuj Chahal
- South Leicestershire Medical Group, Kibworth Beauchamp, UK
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Mayur Lakhani
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Azhar Farooqi
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Riyaz Patel
- Institute of Cardiovascular Science, University College London, London, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
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Zubair M, Bown MJ, Armstrong N. Introducing multi-component cardiovascular health screening into existing Abdominal Aortic Aneurysm (AAA) screening programmes in the UK: a qualitative study of programme staff views. BMC Health Serv Res 2022; 22:569. [PMID: 35477458 PMCID: PMC9046009 DOI: 10.1186/s12913-022-07975-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/13/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cardiovascular disease is a major contributor to poor health in the UK and the leading cause of death in England. Peripheral arterial disease and high blood pressure are conditions that identify individuals at high cardiovascular disease risk, likely to benefit from cardiovascular risk management. Both conditions remain considerably underdiagnosed and untreated. The National Health Service abdominal aortic aneurysm (AAA) screening programmes represent an opportunity to screen for these conditions with potentially minimal additional effort or cost. We explored AAA screening programme staff views on the proposed introduction of such additional screening within AAA screening. METHODS Nine focus groups and seven follow-on interviews were undertaken with 38 AAA screening staff. Our study methods were oriented broadly towards a grounded theory methodology, and data were analysed using thematic analysis. RESULTS Three themes were identified: (i) 'Perceptions of patient experience and health-related outcomes', (ii) 'Opportunities and challenges for programme staff', and (iii) 'Maintaining and improving programme standards'. Staff talked about the high uptake of AAA screening, staff experience and skills in their role, and the programme's high quality standards as both opportunities and potential challenges linked to the proposed additions to AAA screening. While positive about the potential to improve patients' health outcomes, participants had questions about the practicalities of incorporating additional procedures within their time- and resource-constrained context, and how this may reconfigure work processes, roles and relationships. CONCLUSIONS The proposed additions to the programme require taking staff's views into account. Key areas that need to be addressed relate to ensuring follow-up support for patients, clarity around staff responsibilities, and availability of sufficient resources for the programme.
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Affiliation(s)
- Maria Zubair
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Matthew J Bown
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Natalie Armstrong
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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Stone TJ, Brangan E, Chappell A, Harrison V, Horwood J. Telephone outreach by community workers to improve uptake of NHS Health Checks in more deprived localities and minority ethnic groups: a qualitative investigation of implementation. J Public Health (Oxf) 2020; 42:e198-e206. [PMID: 31188440 DOI: 10.1093/pubmed/fdz063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 05/07/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND NHS Health Checks is a national cardiovascular risk assessment and management programme in England. To improve equity of uptake in more deprived, and Black, Asian and minority ethnic (BAME) communities, a novel telephone outreach intervention was developed. The outreach call included an invitation to an NHS Health Check appointment, lifestyle questions, and signposting to lifestyle services. We examined the experiences of staff delivering the intervention. METHODS Thematic analysis of semi-structured interviews with 10 community Telephone Outreach Workers (TOWs) making outreach calls, and 5 Primary Care Practice (PCP) staff they liaised with. Normalization Process Theory was used to examine intervention implementation. RESULTS Telephone outreach was perceived as effective in engaging patients in NHS Health Checks and could reduce related administration burdens on PCPs. Successful implementation was dependent on support from participating PCPs, and tensions between the intervention and other PCP priorities were identified. Some PCP staff lacked clarity regarding the intervention aim and this could reduce the potential to capitalize on TOWs' specialist skills. CONCLUSIONS To maximize the potential of telephone outreach to impact equity, purposeful recruitment and training of TOWs is vital, along with support and integration of TOWs, and the telephone outreach intervention, in participating PCPs.
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Affiliation(s)
- T J Stone
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - E Brangan
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - A Chappell
- Public Health, Bristol City Council, City Hall, Bristol, UK
| | - V Harrison
- Public Health, Bristol City Council, City Hall, Bristol, UK
| | - J Horwood
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK
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Kennedy O, Su F, Pears R, Walmsley E, Roderick P. Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial. BMJ Open 2019; 9:e029420. [PMID: 31542745 PMCID: PMC6756325 DOI: 10.1136/bmjopen-2019-029420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate uptake, risk factor detection and management from the National Health Service (NHS) Health Check (HC). DESIGN This is a quasi-randomised controlled trial where participants were allocated to five cohorts based on birth year. Four cohorts were invited for an NHS HC between April 2011 and March 2015. SETTING 151 general practices in Hampshire, England, UK. PARTICIPANTS 366 005 participants born 1 April 1940-31 March 1976 eligible for an NHS HC. INTERVENTION NHS HC invitation. MAIN OUTCOME MEASURES HC attendance and absolute percentage changes and ORs of (1) detecting cardiovascular disease (CVD) 10-year risk >10% and >20%, smokers, and total cholesterol (TC) >5.5 mmol/L and >7.5 mmol/L; (2) diagnosing hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD) and atrial fibrillation (AF); and (3) new interventions with statins, antihypertensives, antiglycaemics and nicotine replacement therapy (NRT). RESULTS HC attendance rose from 12% to 30% between 2011/2012 and 2014/2015 (p<0.001). HC invitation increased detection of CVD risk >10% (2.0%-3.6, p<0.001) and >20% (0.1%-0.6%, p<0.001-0.392), TC >5.5 mmol/L (4.1%-7.0%, p<0.001) and >7.5 mmol/L (0.3%-0.4% p<0.001), hypertension (0.3%-0.6%, p<0.001-0.003), and interventions with statins (0.2%-0.9%, p<0.001-0.017) and antihypertensives (0.1%-0.6%, p<0.001-0.205). There were no consistent differences in detection of smokers, NRT, or diabetes, AF or CKD. Multivariate analyses showed associations between HC invitation and detecting CVD risk >10% (OR 8.01, 95% CI 7.34 to 8.73) and >20% (5.86, 4.83 to 7.10), TC >5.5 mmol/L (3.72, 3.57 to 3.89) and >7.5 mmol/L (2.89, 2.46 to 3.38), and diagnoses of hypertension (1.33, 1.20 to 1.47) and diabetes (1.34, 1.12 to 1.61). OR of CVD risk >10% plus statin and >20% plus statin, respectively, was 2.90 (2.36 to 3.57) and 2.60 (1.92 to 3.52), and for hypertension plus antihypertensive was 1.33 (1.18 to 1.50). There were no associations with AF, CKD, antiglycaemics or NRT. Detection of several risk factors varied inversely by deprivation. CONCLUSIONS HC invitation increased detection of cardiovascular risk factors, but corresponding increases in evidence-based interventions were modest.
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Affiliation(s)
- Oliver Kennedy
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fangzhong Su
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Robert Pears
- Public Health Directorate, Hampshire County Council, Hampshire, UK
| | - Emily Walmsley
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Roderick
- Faculty of Medicine, University of Southampton, Southampton, UK
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Health checks and cardiovascular risk factor values over six years' follow-up: Matched cohort study using electronic health records in England. PLoS Med 2019; 16:e1002863. [PMID: 31361740 PMCID: PMC6667114 DOI: 10.1371/journal.pmed.1002863] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The National Health Service (NHS) in England introduced a population-wide programme for cardiovascular disease (CVD) prevention in 2009, known as NHS Health Checks. This research aimed to measure the cardiovascular risk management and cardiovascular risk factor outcomes of the health check programme during six years' follow-up. METHODS AND FINDINGS A controlled interrupted time series study was conducted. Participants were registered with general practices in the Clinical Practice Research Datalink (CPRD) in England and received health checks between 1 April 2010 and 31 December 2013. Control participants, who did not receive a health check, were matched for age, sex, and general practice. Outcomes were blood pressure, body mass index (BMI), smoking, and total cholesterol (TC) and high-density lipoprotein cholesterol (HDL). Analyses estimated the net effect of health check by year, allowing for the underlying trend in risk factor values and baseline differences between cases and controls, adjusting for age, sex, deprivation, and clustering by general practice. There were 127,891 health check participants and 322,910 matched controls. Compared with controls, health check participants had lower BMI (cases mean 27.0, SD 4.8; controls 27.3, SD 5.6, Kg/m2), systolic blood pressure (SBP) (cases 129.0, SD 14.3; controls 129.3, SD 15.0, mm Hg), and smoking (21% in health check participants versus 27% in controls), but total and HDL cholesterol were similar. Health check participants were more likely to receive weight management advice (adjusted hazard ratio [HR] 5.03, 4.98 to 5.08, P < 0.001), smoking cessation interventions (HR 3.20, 3.13 to 3.27, P < 0.001), or statins (HR 1.24, 1.21 to 1.27, P < 0.001). There were net reductions in risk factor values up to six years after the check for BMI (-0.30, -0.39 to -0.20 Kg/m2, P < 0.001), SBP (-1.43, -1.70 to -1.16 mm Hg, P < 0.001), and smoking (17% in health check participants versus 25% in controls; odds ratio 0.90, 0.87 to 0.94, P < 0.001). The main study limitation was that residual confounding may be present because randomisation was not employed; health check-associated measurement introduced differential recording that might cause bias. CONCLUSIONS Our results suggest that people who take up a health check generally have lower risk factor values than controls and are more likely to receive risk factor interventions. Risk factor values show net reductions up to six years following a health check in BMI, blood pressure, and smoking, which may be of public health importance.
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Chattopadhyay K, Biswas M, Moore R. NHS Health Check and healthy lifestyle in Leicester, England: analysis of a survey dataset. Perspect Public Health 2019; 140:27-37. [PMID: 31070547 DOI: 10.1177/1757913919834584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS A major component of the National Health Service (NHS) Health Check in England is to provide lifestyle advice to eligible participants. The aims of the study were to explore the variations (in terms of uptake) in the NHS Health Check in Leicester and to determine its association with a healthy lifestyle. METHODS This cross-sectional study used data from the Leicester Health and Wellbeing Survey (2015). RESULTS The odds of having an NHS Health Check were found to be higher in Black and minority ethnic groups and in people of other religions. The odds were lower in people without a religion, residing in the fourth index of multiple deprivation quintile and in ex-smokers. No associations were found between having an NHS Health Check and describing a healthy lifestyle, following a healthy lifestyle, thinking of making lifestyle changes in the next 6 months, cutting down on/stopping smoking among current smokers, or amount of alcohol current drinkers would like to drink. CONCLUSIONS In Leicester, a few variations in having an NHS Health Check were found among different socio-economic, demographic and behavioural groups. No association was found between the NHS Health Check and a healthy lifestyle. Thus, the improvement work should focus on reducing these variations in having the NHS Health Check and bringing its benefits on promoting a healthy lifestyle.
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Affiliation(s)
- K Chattopadhyay
- Assistant Professor in Evidence Based Healthcare, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK
| | - M Biswas
- Research Fellow in Health Economics, Centre for Reviews and Dissemination, University of York, York, UK
| | - R Moore
- Consultant in Public Health, Leicester City Council, Leicester, UK; Honorary Senior Lecturer, Department of Health Sciences, University of Leicester, Leicester, UK
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Brangan E, Stone TJ, Chappell A, Harrison V, Horwood J. Patient experiences of telephone outreach to enhance uptake of NHS Health Checks in more deprived communities and minority ethnic groups: A qualitative interview study. Health Expect 2018; 22:364-372. [PMID: 30585389 PMCID: PMC6543263 DOI: 10.1111/hex.12856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/12/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022] Open
Abstract
Background The NHS Health Checks preventative programme aims to reduce cardiovascular morbidity across England. To improve equity in uptake, telephone outreach was developed in Bristol, involving community workers telephoning patients amongst communities potentially at higher risk of cardiovascular disease and/or less likely to take up a written invitation, to engage them with NHS Health Checks. Where possible, caller cultural background/main language is matched with that of the patient called. The call includes an invitation to book an NHS Health Check appointment, lifestyle questions from the Health Check, and signposting to lifestyle services. Objective To explore the experiences of patients who received an outreach call. Design/Setting/Participants Thematic analysis of semi‐structured interviews with 24 patients (15 female), from seven primary care practices, who had received an outreach call. Results The call increased participants’ understanding of NHS Health Checks and overcame anticipated difficulties with making an appointment. Half reported that they would not have booked if only invited by letter. The cultural identity/language skills of the caller were important in facilitating the interaction for some who might otherwise encounter language or cultural barriers. The inclusion of lifestyle questions and signposting prompted a minority to make lifestyle changes. Conclusions Participants valued easily generalizable aspects of the intervention—a telephone invitation with ability to book during the call—and reported that it prompted acceptance of an NHS Health Check. A caller who shared their main language/cultural background was important for a minority of participants, and improved targeting of this would be beneficial.
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Affiliation(s)
- Emer Brangan
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,The Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey J Stone
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,The Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Jeremy Horwood
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,The Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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10
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Alageel S, Gulliford MC, McDermott L, Wright AJ. Implementing multiple health behaviour change interventions for cardiovascular risk reduction in primary care: a qualitative study. BMC FAMILY PRACTICE 2018; 19:171. [PMID: 30376826 PMCID: PMC6208114 DOI: 10.1186/s12875-018-0860-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/19/2018] [Indexed: 01/17/2023]
Abstract
Background The implementation of multiple health behaviour change interventions for cardiovascular risk reduction in primary care is suboptimal. This study aimed to identify barriers and facilitators to implementing multiple health behaviour change interventions for cardiovascular disease (CVD) risk reduction in primary care. Methods Qualitative study using semi-structured interviews informed by the Theoretical Domains Framework. Interviews were conducted with a purposive sample of healthcare professionals working in the implementation of the NHS Health Check programme in London. Data were analysed using the Framework method. Results Thirty participants were recruited including ten general practitioners, ten practice nurses, seven healthcare assistants and three practice managers from 23 practices. Qualitative analysis identified three main themes: healthcare professionals’ conceptualising health behaviour change; delivering multiple health behaviour change interventions in primary care; and delivering the health check programme. Healthcare professionals generally recognised the importance of health behaviour change for CVD risk reduction but were more sceptical about the potential for successful intervention through primary care. Participants identified the difficulty of sustained behaviour change for patients, the lack of evidence for effective interventions and limited access to appropriate resources in primary care as barriers. Discussing changing multiple health behaviours was perceived to be overwhelming for patients and difficult to implement for healthcare professionals with current primary care resources. The health check programme consists of several components that are difficult to fully complete in limited time. Conclusions Advancing the prevention agenda will require strategies to support the delivery of behaviour change interventions in primary care. Greater emphasis needs to be given to promoting behaviour change through supportive environmental context. Further research is needed to evaluate current external lifestyle services to improve the intervention outcomes. Electronic supplementary material The online version of this article (10.1186/s12875-018-0860-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samah Alageel
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Martin C Gulliford
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Lisa McDermott
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Alison J Wright
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
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11
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Gulliford MC, Khoshaba B, McDermott L, Cornelius V, Ashworth M, Fuller F, Miller J, Dodhia H, Wright AJ. Cardiovascular risk at health checks performed opportunistically or following an invitation letter. Cohort study. J Public Health (Oxf) 2018. [PMID: 28633511 PMCID: PMC6053837 DOI: 10.1093/pubmed/fdx068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background A population-based programme of health checks has been established in England. Participants receive postal invitations through a population-based call–recall system but health check providers may also offer health checks opportunistically. We compared cardiovascular risk scores for ‘invited’ and ‘opportunistic’ health checks. Methods Cohort study of all health checks completed at 18 general practices from July 2013 to June 2015. For each general practice, cardiovascular (CVD) risk scores were compared by source of check and pooled using meta-analysis. Effect estimates were compared by gender, age-group, ethnicity and fifths of deprivation. Results There were 6184 health checks recorded (2280 invited and 3904 opportunistic) with CVD risk scores recorded for 5359 (87%) participants. There were 17.0% of invited checks and 22.2% of opportunistic health checks with CVD risk score ≥10%; a relative increment of 28% (95% confidence interval: 14–44%, P < 0.001). In the most deprived quintile, 15.3% of invited checks and 22.4% of opportunistic checks were associated with elevated CVD risk (adjusted odds ratio: 1.94, 1.37–2.74, P < 0.001). Conclusions Respondents at health checks performed opportunistically are at higher risk of cardiovascular disease than those participating in response to a standard invitation letter, potentially reducing the effect of uptake inequalities.
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Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' Hospital, London, UK
| | - Bernadette Khoshaba
- Department of Primary Care and Public Health Sciences, King's College, London, UK
| | - Lisa McDermott
- Department of Primary Care and Public Health Sciences, King's College, London, UK
| | - Victoria Cornelius
- Department of Primary Care and Public Health Sciences, King's College, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College, London, UK
| | - Frances Fuller
- Public Health Directorate, Lewisham Borough Council, London, UK
| | - Jane Miller
- Public Health Directorate, Lewisham Borough Council, London, UK
| | - Hiten Dodhia
- Public Health Directorate, Lambeth Borough Council, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, King's College, London, UK
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McDermott L, Cornelius V, Wright AJ, Burgess C, Forster AS, Ashworth M, Khoshaba B, Clery P, Fuller F, Miller J, Dodhia H, Rudisill C, Conner MT, Gulliford MC. Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care. Ann Behav Med 2018; 52:594-605. [PMID: 29860363 PMCID: PMC6361284 DOI: 10.1093/abm/kax048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake. Purpose The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks. Methods We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance. Results 12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41%); QBE questionnaire, 630 / 3,988 (15.80%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85%). Difference following QBE questionnaire, 1.43% (95% confidence interval -0.12 to 2.97%, p = .070); following QBE questionnaire and financial incentive, 1.52% (-0.03 to 3.07%, p = .054). Conclusions Uptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.
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Affiliation(s)
- Lisa McDermott
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
| | - Victoria Cornelius
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
| | - Caroline Burgess
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
| | - Alice S Forster
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
| | - Bernadette Khoshaba
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
| | - Philippa Clery
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
| | - Frances Fuller
- Public Health, Community Services Directorate, Lewisham Borough Council, Laurence House, London, UK
| | - Jane Miller
- Public Health, Community Services Directorate, Lewisham Borough Council, Laurence House, London, UK
| | - Hiten Dodhia
- Public Health Directorate, Lambeth Borough Council, Phoenix House, London, UK
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics and Political Science, Houghton St, London, UK
| | - Mark T Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s Campus, London, UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospital, Guy’s Hospital, London, UK
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13
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Riley VA, Gidlow C, Ellis NJ. Understanding implementation and uptake in the National Health Service Health Check Programme. Public Health 2018; 159:63-66. [PMID: 29580560 DOI: 10.1016/j.puhe.2018.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES We present findings from a national online survey of uptake and implementation of the National Health Service Health Check (NHSHC) programme. The research aimed to understand national variation in implementation of NHSHCs and to explore the relationship between uptake and different components of implementation. STUDY DESIGN The study design was a descriptive online survey. METHODS Data were collected via an online survey between November 2015 and August 2016. The survey was distributed nationally to practice managers in the Midlands and East of England, South of England, North of England and London via local NHSHC leads with the help of the national programme manager. RESULTS Responses were received from 153 participants, half of who were practice managers (49.7%). Common components of implementation included using postal invitations accompanied by the national leaflet, delivering NHSHCs routinely with other appointments, offering NHSHC outside of working hours and taking blood samples during the consultation. Meaningful exploration of the relationship between uptake and components of implementation was not possible given the inaccuracy of self-reported uptake data, which was confirmed by comparison with public health data in a subsample (n = 18). The comparison also found that a number of practices were reporting more completed health checks than the total number of patients invited, which again indicates problems that may have implications for uptake figures locally and nationally. CONCLUSIONS Overall, our findings showed considerable variation in the implementation of NHSHCs on a national scale and issues with quality of programme uptake data, which has implications for national reporting for NHSHC.
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Affiliation(s)
- V A Riley
- Staffordshire University, School of Life Sciences and Education, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - C Gidlow
- Staffordshire University, School of Life Sciences and Education, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - N J Ellis
- Staffordshire University, School of Life Sciences and Education, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
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14
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Stol DM, Hollander M, Nielen MMJ, Badenbroek IF, Schellevis FG, de Wit NJ. Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared? Scand J Prim Health Care 2018; 36:20-27. [PMID: 29357728 PMCID: PMC5901436 DOI: 10.1080/02813432.2018.1426151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. DESIGN Observational study. SETTING Dutch primary care. SUBJECTS General practices. MAIN OUTCOME MEASURES Organizational characteristics. RESULTS General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). CONCLUSIONS The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices. • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention. • Implementation of selective CMD prevention programs including easily accessible services for lifestyle support should be the focus of attention. • Policy makers, health insurance companies and healthcare professionals share the responsibility to realize structural funding for selective CMD prevention.
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Affiliation(s)
- Daphne M. Stol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- CONTACT Daphne M. Stol Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, Utrecht, 3508 GA, The Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Markus M. J. Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ilse F. Badenbroek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - François G. Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Niek J. de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Mills K, Harte E, Martin A, MacLure C, Griffin SJ, Mant J, Meads C, Saunders CL, Walter FM, Usher-Smith JA. Views of commissioners, managers and healthcare professionals on the NHS Health Check programme: a systematic review. BMJ Open 2017; 7:e018606. [PMID: 29146658 PMCID: PMC5695333 DOI: 10.1136/bmjopen-2017-018606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To synthesise data concerning the views of commissioners, managers and healthcare professionals towards the National Health Service (NHS) Health Check programme in general and the challenges faced when implementing it in practice. DESIGN A systematic review of surveys and interview studies with a descriptive analysis of quantitative data and thematic synthesis of qualitative data. DATA SOURCES An electronic literature search of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the International Standard Randomised Controlled Trial Number registry from 1 January 1996 to 9 November 2016 with no language restriction and manual screening of reference lists of all included papers. INCLUSION CRITERIA Primary research reporting views of commissioners, managers or healthcare professionals on the NHS Health Check programme and its implementation in practice. RESULTS Of 18 524 citations, 15 articles met the inclusion criteria. There was evidence from both quantitative and qualitative studies that some commissioners and general practice (GP) healthcare professionals were enthusiastic about the programme, whereas others raised concerns around inequality of uptake, the evidence base and cost-effectiveness. In contrast, those working in pharmacies were all positive about programme benefits, citing opportunities for their business and staff. The main challenges to implementation were: difficulties with information technology and computer software, resistance to the programme from some GPs, the impact on workload and staffing, funding and training needs. Inadequate privacy was also a challenge in pharmacy and community settings, along with difficulty recruiting people eligible for Health Checks and poor public access to some venues. CONCLUSIONS The success of the NHS Health Check Programme relies on engagement by those responsible for its commissioning, management and delivery. Recognising and addressing the challenges identified in this review, in particular the concerns of GPs, are important for the future of the programme.
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Affiliation(s)
- Katie Mills
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Emma Harte
- RAND Europe, Westbrook Centre, Cambridge, UK
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Simon J Griffin
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
| | - Jonathan Mant
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Catherine Meads
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
| | - Catherine L Saunders
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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El-Osta A, Woringer M, Pizzo E, Verhoef T, Dickie C, Ni MZ, Huddy JR, Soljak M, Hanna GB, Majeed A. Does use of point-of-care testing improve cost-effectiveness of the NHS Health Check programme in the primary care setting? A cost-minimisation analysis. BMJ Open 2017; 7:e015494. [PMID: 28814583 PMCID: PMC5724165 DOI: 10.1136/bmjopen-2016-015494] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine if use of point of care testing (POCT) is less costly than laboratory testing to the National Health Service (NHS) in delivering the NHS Health Check (NHSHC) programme in the primary care setting. DESIGN Observational study and theoretical mathematical model with microcosting approach. SETTING We collected data on NHSHC delivered at nine general practices (seven using POCT; two not using POCT). PARTICIPANTS We recruited nine general practices offering NHSHC and a pathology services laboratory in the same area. METHODS We conducted mathematical modelling with permutations in the following fields: provider type (healthcare assistant or nurse), type of test performed (total cholesterol with either lab fasting glucose or HbA1c), cost of consumables and variable uptake rates, including rate of non-response to invite letter and rate of missed [did not attend (DNA)] appointments. We calculated total expected cost (TEC) per 100 invites, number of NHSHC conducted per 100 invites and costs for completed NHSHC for laboratory and POCT-based pathways. A univariate and probabilistic sensitivity analysis was conducted to account for uncertainty in the input parameters. MAIN OUTCOME MEASURES We collected data on cost, volume and type of pathology services performed at seven general practices using POCT and a pathology services laboratory. We collected data on response to the NHSHC invitation letter and DNA rates from two general practices. RESULTS TEC of using POCT to deliver a routine NHSHC is lower than the laboratory-led pathway with savings of £29 per 100 invited patients up the point of cardiovascular disease risk score presentation. Use of POCT can deliver NHSHC in one sitting, whereas the laboratory pathway offers patients several opportunities to DNA appointment. CONCLUSIONS TEC of using POCT to deliver an NHSHC in the primary care setting is lower than the laboratory-led pathway. Using POCT minimises DNA rates associated with laboratory testing and enables completion of NHSHC in one sitting.
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Affiliation(s)
- Austen El-Osta
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Maria Woringer
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Talitha Verhoef
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Claire Dickie
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Melody Z Ni
- Department of Surgery and Cancer, NIHR DEC London, Imperial College London, London W2 JNY, UK
| | - Jeremy R Huddy
- Department of Surgery and Cancer, NIHR DEC London, Imperial College London, London W2 JNY, UK
| | - Michael Soljak
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - George B Hanna
- Department of Surgery and Cancer, NIHR DEC London, Imperial College London, London W2 JNY, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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Robson J, Dostal I, Madurasinghe V, Sheikh A, Hull S, Boomla K, Griffiths C, Eldridge S. NHS Health Check comorbidity and management: an observational matched study in primary care. Br J Gen Pract 2017; 67:e86-e93. [PMID: 27993901 PMCID: PMC5308122 DOI: 10.3399/bjgp16x688837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The NHS Health Check programme completed its first 5 years in 2014, identifying those at highest risk of cardiovascular disease and new comorbidities, and offering behavioural change support and treatment. AIM To describe the coverage and impact of this programme on cardiovascular risk management and identification of new comorbidities. DESIGN AND SETTING Observational 5-year study from April 2009 to March 2014, in 139 of 143 general practices in three clinical commissioning groups (CCGs) in east London. METHOD A matched analysis compared comorbidity in NHS Health Check attendees and non-attendees. RESULTS A total of 252 259 adults aged 40-74 years were eligible for an NHS Health Check and, of these, 85 122 attended in 5 years. Attendance increased from 7.3% (10 900/149 867) in 2009 to 17.0% (18 459/108 525) in 2013 to 2014, representing increasing coverage from 36.4% to 85.0%. Attendance was higher in the more deprived quintiles and among South Asians. Statins were prescribed to 11.5% of attendees and 8.2% of non-attendees. In a matched analysis, newly-diagnosed comorbidity was more likely in attendees than non-attendees, with odds ratios for new diabetes 1.30 (95% confidence interval [CI] = 1.21 to 1.39), hypertension 1.50 (95% CI = 1.43 to 1.57), and chronic kidney disease 1.83 (95% CI = 1.52 to 2.21). CONCLUSION The NHS Health Check programme provision in these CCGs was equitable, with recent coverage of 85%. Statins were 40% more likely to be prescribed to attendees than non-attendees, providing estimated absolute benefits of public health importance. More new cases of diabetes, hypertension, and chronic kidney disease were identified among attendees than a matched group of non-attendees.
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Affiliation(s)
- John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Isabel Dostal
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | | | - Aziz Sheikh
- Centre for Primary Care and Public Health, eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh
| | - Sally Hull
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Kambiz Boomla
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London
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Forster AS, Burgess C, Dodhia H, Fuller F, Miller J, McDermott L, Gulliford MC. Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records. J Public Health (Oxf) 2016; 38:552-559. [PMID: 26350481 PMCID: PMC5072161 DOI: 10.1093/pubmed/fdv119] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To evaluate the effect of NHS Health Checks on cardiovascular risk factor detection and inequalities. METHODS Matched cohort study in the Clinical Practice Research Datalink, including participants who received a health check in England between 1 April 2010 and 31 March 2013, together with matched control participants, with linked deprivation scores. RESULTS There were 91 618 eligible participants who received a health check, of whom 75 123 (82%) were matched with 182 245 controls. After the health check, 90% of men and 92% of women had complete data for blood pressure, total cholesterol, smoking and body mass index; a net 51% increase (P < 0.001) over controls. After the check, gender and deprivation inequalities in recording of all risk factors were lower than for controls. Net increase in risk factor detection was greater for hypercholesterolaemia (men +33%; women +32%) than for obesity (men +8%; women +4%) and hypertension in men only (+5%) (all P < 0.001). Detection of smoking was 5% lower in health check participants than controls (P < 0.001). Over 4 years, statins were prescribed to 11% of health -check participants and 7.6% controls (hazard ratio 1.58, 95% confidence interval 1.53-1.63, P < 0.001). CONCLUSION NHS Health Checks are associated with increased detection of hypercholesterolaemia, and to a lesser extent obesity and hypertension, but smokers may be under-represented.
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Affiliation(s)
- Alice S Forster
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Caroline Burgess
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Hiten Dodhia
- Public Health Directorate, London Boroughs of Lambeth and Southwark, London, UK
| | - Frances Fuller
- Department of Public Health, London Borough of Lewisham, London, UK
| | - Jane Miller
- Department of Public Health, London Borough of Lewisham, London, UK
| | - Lisa McDermott
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Targeted case finding in the prevention of cardiovascular disease: a stepped wedge cluster randomised controlled trial. Br J Gen Pract 2016; 66:e758-67. [PMID: 27528707 DOI: 10.3399/bjgp16x686629] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/17/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Individuals at high risk of cardiovascular disease (CVD) are undertreated. AIM To evaluate the effectiveness of a programme of targeted, nurse-led case finding for CVD prevention in primary care. DESIGN AND SETTING Targeted case finding for CVD prevention was implemented in urban West Midlands general practices between February 2009 and August 2012, and evaluated as a stepped wedge cluster randomised trial. METHOD Untreated patients aged 35-74 years and at ≥20% 10-year CVD risk were identified, invited for assessment by a project nurse, and referred to their GP for treatment initiation. The primary outcome was the proportion of high-risk patients prescribed antihypertensives or statins after exposure to the intervention compared with an equivalent period of time prior to exposure. Secondary outcomes included assessment of CVD risk factors. RESULTS In 26 sequentially randomised general practices the exposed group consisted of 2926 untreated high-risk patients identified at the start of the intervention, with 2969 patients identified at the start of the unexposed period. The trial was well balanced in terms of age, sex, and cardiovascular risk factors. In the exposed period 19.7% of patients were prescribed antihypertensives or statins, and 10.8% of patients in the unexposed period. After adjustment for clustering and temporal effects the risk difference was 15.5% (95% CI = 3.9 to 27.1, P = 0.009). Assessment of lipid levels increased significantly, at 26.4% (99% CI = 5.3 to 47.5, P = 0.001) CONCLUSION: Targeted case finding programmes can increase the number of high-risk patients started on antihypertensive and statin treatment.
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20
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Robson J, Dostal I, Sheikh A, Eldridge S, Madurasinghe V, Griffiths C, Coupland C, Hippisley-Cox J. The NHS Health Check in England: an evaluation of the first 4 years. BMJ Open 2016; 6:e008840. [PMID: 26762161 PMCID: PMC4735215 DOI: 10.1136/bmjopen-2015-008840] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/01/2015] [Accepted: 09/28/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To describe implementation of a new national preventive programme to reduce cardiovascular morbidity. DESIGN Observational study over 4 years (April 2009--March 2013). SETTING 655 general practices across England from the QResearch database. PARTICIPANTS Eligible adults aged 40-74 years including attendees at a National Health Service (NHS) Health Check. INTERVENTION NHS Health Check: routine structured cardiovascular check with support for behavioural change and in those at highest risk, treatment of risk factors and newly identified comorbidity. RESULTS Of 1.68 million people eligible for an NHS Health Check, 214 295 attended in the period 2009-12. Attendance quadrupled as the programme progressed; 5.8% in 2010 to 30.1% in 2012. Attendance was relatively higher among older people, of whom 19.6% of those eligible at age 60-74 years attended and 9.0% at age 40-59 years. Attendance by population groups at higher cardiovascular disease (CVD) risk, such as the more socially disadvantaged 14.9%, was higher than that of the more affluent 12.3%. Among attendees 7844 new cases of hypertension (38/1000 Checks), 1934 new cases of type 2 diabetes (9/1000 Checks) and 807 new cases of chronic kidney disease (4/1000 Checks) were identified. Of the 27,624 people found to be at high CVD risk (20% or more 10-year risk) when attending an NHS Health Check, 19.3% (5325) were newly prescribed statins and 8.8% (2438) were newly prescribed antihypertensive therapy. CONCLUSIONS NHS Health Check coverage was lower than expected but showed year-on-year improvement. Newly identified comorbidities were an important feature of the NHS Health Checks. Statin treatment at national scale for 1 in 5 attendees at highest CVD risk is likely to have contributed to important reductions in their CVD events.
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Affiliation(s)
- John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Isabel Dostal
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Carol Coupland
- School of Community Health Sciences, The University of Nottingham, Nottingham, UK
| | - Julia Hippisley-Cox
- School of Community Health Sciences, The University of Nottingham, Nottingham, UK
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Lambert MF. Assessing potential local routine monitoring indicators of reach for the NHS health checks programme. Public Health 2015; 131:92-8. [PMID: 26715314 DOI: 10.1016/j.puhe.2015.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 08/26/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Success in reaching target populations is an important factor in determining the impact of public health programmes. The NHS Health Check (NHSHC) Programme is directed towards reducing excess cardiovascular mortality in England. As the programme is locally commissioned, local monitoring of programme reach is essential. This study aimed to assess indicators of programme reach available to local service commissioners. STUDY DESIGN Ecological. METHODS The programme reach of NHSHC was assessed in three health districts in the North East of England. Local data returned from GP practices to commissioners on their NHSHC activities was collated for the period October 2010 to March 2013 together with related national published data. Three candidate indicators were chosen and the association between each of these and NHSHCs at GP practice level was examined by univariate logistic regression. RESULTS Data were available from 101 GP practices, together undertaking almost 20,000 health checks a year. Number of NHSHCs by practices explained most (77-92%) of the variance the numbers identified at high risk of cardiovascular disease (two for every ten NHSHCs). NHSHCs were not associated with growth in GP practice disease registers for either diabetes or hypertension. NHSCHs predicted practices identification of new cases of hypertension (with one case identified for every ten checks), albeit the proportion of variation explained was much more variable (2-60%) less consistent effect. CONCLUSIONS Data routinely available to NHSHC commissioners can support monitoring programme reach, with numbers of new cases of hypertension being the most promising indicator of reach.
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Affiliation(s)
- Mark F Lambert
- Public Health England, Waterfront 4, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne, United Kingdom; Department of Health Sciences, University of York, York, United Kingdom.
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Baker C, Loughren EA, Crone D, Kallfa N. Perceptions of health professionals involved in a NHS Health Check care pathway. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/pnur.2015.26.12.608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Colin Baker
- Research fellow, University of Gloucestershire
| | | | - Diane Crone
- Professor of exercise science, University of Gloucestershire
| | - Nevila Kallfa
- Consultant in public health, Public Health England (former Consultant in Public Health at Gloucestershire County Council)
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Implementation of NHS Health Checks in general practice: variation in delivery between practices and practitioners. Prim Health Care Res Dev 2015; 17:385-92. [PMID: 26522491 DOI: 10.1017/s1463423615000493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
UNLABELLED Aim To evaluate NHS Health Check implementation in terms of frequency of data recording, advice provided, referrals to community-based lifestyle support services, statin prescribing and new diagnoses, and to assess variation in these aspects between practices and health professionals involved in delivery. BACKGROUND Most NHS Health Checks are delivered by general practices, but little detail is known about the extent of variation in how they are delivered in different practices and by different health professionals. METHODS This was an observational study conducted in a purposively selected sample of 13 practices in Sefton, North West England. Practices used previously recorded information from their clinical management systems to identify patients with cardiovascular disease (CVD) risk ⩾20%, a potentially cost-effective approach. The evaluation was conducted during the first year of delivery in Sefton. Data were extracted from medical records of all patients identified, regardless of Health Check attendance. Findings Of the 2892 patients identified by the 13 practices, 1070 had received an NHS Health Check at the time of the study. Of these, only 936 (87.5%) had a recorded CVD risk score, with risk ⩾20% confirmed in 92.0%. Estimated risk category was correct in 456/677 (67.4%) of patients with estimated and actual risk scores. Significant variation was found between practices and health professionals in parameters recorded, tests requested, advice given and referrals for lifestyle support. Only 45.3% of patients had body mass index, smoking, alcohol, exercise, blood pressure and cholesterol all recorded. Lifestyle advice and referral into lifestyle services were documented in 80.6% and 6.4% of attenders, respectively, again with significant variation between practices and professionals. Statin prescribing rose in attenders from 19.6% to 34.6%. A similar proportion of attenders and non-attenders received new diagnoses. CONCLUSION Effort is required to reduce variation in how practices deliver and follow-up NHS Health Checks, to ensure the consistency of the programme.
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Ismail H, Kelly S. Lessons learned from England's Health Checks Programme: using qualitative research to identify and share best practice. BMC FAMILY PRACTICE 2015; 16:144. [PMID: 26486126 PMCID: PMC4618054 DOI: 10.1186/s12875-015-0365-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/08/2015] [Indexed: 11/19/2022]
Abstract
Background This study aimed to explore the challenges and barriers faced by staff involved in the delivery of the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program in primary care. Methods Data have been derived from three qualitative evaluations that were conducted in 25 General Practices and involved in depth interviews with 58 staff involved all levels of the delivery of the Health Checks. Analysis of the data was undertaken using the framework approach and findings are reported within the context of research and practice considerations. Results Findings indicated that there is no ‘one size fits all’ blueprint for maximising uptake although success factors were identified: evolution of the programme over time in response to local needs to suit the particular characteristics of the patient population; individual staff characteristics such as being proactive, enthusiastic and having specific responsibility; a supportive team. Training was clearly identified as an area that needed addressing and practitioners would benefit from CVD specific baseline training and refresher courses to keep them up to date with recent developments in the area. However there were other external factors that impinged on an individual’s ability to provide an effective service, some of these were outside the control of individuals and included cutbacks in referral services, insufficient space to run clinics or general awareness of the Health Checks amongst patients. Conclusions The everyday experiences of practitioners who participated in this study suggest that overall, Health Check is perceived as a worthwhile exercise. But, organisational and structural barriers need to be addressed. We also recommend that clear referral pathways be in place so staff can refer patients to appropriate services (healthy eating sessions, smoking cessation, and exercise referrals). Local authorities need to support initiatives that enable data sharing and linkage so that GP Practices are informed when patients take up services such as smoking cessation or alcohol harm reduction programmes run by social services. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0365-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanif Ismail
- Centre for Health & Social Care Research, Sheffield Hallam University, Sheffield, UK. .,Department of Health & Life Sciences, York St John University, York, UK.
| | - Shona Kelly
- Centre for Health & Social Care Research, Sheffield Hallam University, Sheffield, UK.
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Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
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Views of practice managers and general practitioners on implementing NHS Health Checks. Prim Health Care Res Dev 2015; 17:198-205. [PMID: 25991495 DOI: 10.1017/s1463423615000262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
As part of an evaluation of a contract with general practices to deliver the national NHS Health Checks programme in Sefton, North West England, we surveyed general practitioners (GPs) and practice managers (PMs) in all 55 practices. The contract required practices to identify individuals from their practice registers with potentially high cardiovascular disease risk, and provide annual reviews. Responses were obtained from 43/178 GPs and 40/55 PMs representing 56 and 73% of practices, respectively. There was variation in many aspects of implementation. Time and software were viewed as barriers to implementation, the increased nurse workload impacted on other services and payments were insufficient to cover costs. The main enabler for successful implementation was IT support. Fewer than half the respondents viewed the programme as beneficial to their practice. Findings have been used to address many issues raised. Practices need more support from commissioners to help implement NHS Health Checks.
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Robson J, Dostal I, Madurasinghe V, Sheikh A, Hull S, Boomla K, Page H, Griffiths C, Eldridge S. The NHS Health Check programme: implementation in east London 2009-2011. BMJ Open 2015; 5:e007578. [PMID: 25869692 PMCID: PMC4401839 DOI: 10.1136/bmjopen-2015-007578] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe implementation and results from the National Health Service (NHS) Health Check programme. DESIGN Three-year observational open cohort study: 2009-2011. PARTICIPANTS People of age 40-74 years eligible for an NHS Health Check. SETTING 139/143 general practices in three east London primary care trusts (PCTs) serving an ethnically diverse and socially disadvantaged population. METHOD Implementation was supported with education, IT support and performance reports. Tower Hamlets PCT additionally used managed practice networks and prior-stratification to call people at higher cardiovascular (CVD) risk first. MAIN OUTCOMES MEASURES Attendance, proportion of high-risk population on statins and comorbidities identified. RESULTS Coverage 2009, 2010, 2011 was 33.9% (31,878/10,805), 60.6% (30,757/18,652) and 73.4% (21,194/28,890), respectively. Older people were more likely to attend than younger people. Attendance was similar across deprivation quintiles and was in accordance with population distributions of black African/Caribbean, South Asian and White ethnic groups. 1 in 10 attendees were at high-CVD risk (20% or more 10-year risk). In the two PCTs stratifying risk, 14.3% and 9.4% of attendees were at high-CVD risk compared to 8.6% in the PCT using an unselected invitation strategy. Statin prescription to people at high-CVD risk was higher in Tower Hamlets 48.9%, than in City and Hackney 23.1% or Newham 20.2%. In the 6 months following an NHS Health Check, 1349 new cases of hypertension, 638 new cases of diabetes and 89 new cases of chronic kidney disease (CKD) were diagnosed. This represents 1 new case of hypertension per 38 Checks, 1 new case of diabetes per 80 Checks and 1 new case of CKD per 568 Checks. CONCLUSIONS Implementation of the NHS Health Check programme in these localities demonstrates limited success. Coverage and treatment of those at high-CVD risk could be improved. Targeting invitations to people at high-CVD risk and managed practice networks in Tower Hamlets improved performance.
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Affiliation(s)
- John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Isabel Dostal
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Aziz Sheikh
- Centre for Population Health Sciences, the University of Edinburgh, Edinburgh, UK
| | - Sally Hull
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Kambiz Boomla
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Helen Page
- London Borough of Newham, Newham Dockside, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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The NHS Health Check programme: a comparison against established standards for screening. Br J Gen Pract 2014; 64:530-1. [PMID: 25267043 DOI: 10.3399/bjgp14x681997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Maindal HT, Støvring H, Sandbaek A. Effectiveness of the population-based Check your health preventive programme conducted in primary care with 4 years follow-up [the CORE trial]: study protocol for a randomised controlled trial. Trials 2014; 15:341. [PMID: 25169211 PMCID: PMC4158060 DOI: 10.1186/1745-6215-15-341] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The periodic health check-up has been a fundamental part of routine medical practice for decades, despite a lack of consensus regarding its value in health promotion and disease prevention. A large-scale Danish population-based preventive programme 'Check your health' was developed based on available evidence of screening and successive accepted treatment, prevention for diseases and health promotion, and is closely aligned with the current health care system.The objective of the 'Check your health' [CORE] trial is to investigate effectiveness on health outcomes of a preventive health check offered at a population-level to all individuals aged 30-49 years, and to establish the cost-effectiveness. METHODS/DESIGN The trial will be conducted as a pragmatic household-cluster randomised controlled trial involving 10,505 individuals. All individuals within a well-defined geographical area in the Central Denmark Region, Denmark (DK) were randomised to be offered a preventive health check (Intervention group, n = 5250) or to maintain routine access to healthcare until a delayed intervention (Comparison group, n = 5255). The programme consists of a health examination which yields an individual risk profile, and according to this participants are assigned to one of the following interventions: (a) referral to a health promoting consultation in general practice, (b) behavioural programmes at the local Health Centre, or (c) no need for follow-up.The primary outcomes at 4 years follow-up are: ten-year-risk of fatal cardiovascular event (Heart-SCORE model), physical activity level (self-report and cardiorespiratory fitness), quality of life (SF12), sick leave and labour market attachment. Cost-effectiveness will be evaluated according to life years gained, direct costs and total health costs. Intention to treat analysis will be performed. DISCUSSION Results from the largest Danish health check programme conducted within the current healthcare system, spanning the sectors which share responsibility for the individual, will provide a scientific basis to be used in the development of systems to optimise population health in the 21st century. TRIAL REGISTRATION The trial has registered at ClinicalTrials.gov with an ID: NCT02028195 (7. March 2014).
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Affiliation(s)
- Helle Terkildsen Maindal
- Department of Public Health, Health Promotion and Health Services, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
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Krska J, du Plessis R, Chellaswamy H. Views and experiences of the NHS Health Check provided by general medical practices: cross-sectional survey in high-risk patients. J Public Health (Oxf) 2014; 37:210-7. [PMID: 25118218 DOI: 10.1093/pubmed/fdu054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Since the NHS Health Check programme was initiated in 2009, no survey has sought patients' views of Checks provided by GP practices and few studies have reported views of the wider public. This study sought the views and experiences of patients with potentially high-cardiovascular disease (CVD) risk. METHODS Cross-sectional postal survey of all the patients with an actual or estimated CVD risk score of at least 20% over 10 years, registered with 16 general practices in Sefton, North West England, with no follow-up. RESULTS The response rate was 23.4% (644/2958), 67.4% had attended and 73.8% of those not yet invited indicated willingness to attend. Both groups had positive views towards Health Checks, but more non-attenders agreed these should only be performed by doctors. Attenders had better self-reported health and healthy lifestyle than non-attenders. Overall 86.6% of attenders recalled receiving one or more pieces of lifestyle advice and 71.0% claimed to have made at least one lifestyle change; however, perception and understanding of CVD risk appeared limited. CONCLUSION Both attenders and non-attenders had positive views towards NHS Health Checks in general practice and resultant self-reported lifestyle change in attenders was high. Clearer written information and explanation of personal CVD risk are required.
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Affiliation(s)
- Janet Krska
- Universities of Greenwich and Kent, Chatham Maritime, ME4 4TB Kent UK
| | - Ruth du Plessis
- Cheshire and Merseyside Public Health Collaborative Service, Southwood Road, Bromborough, CH62 3QX Wirral, UK
| | - Hannah Chellaswamy
- Sefton Council Public Health Department, Deputy Director of Public Health, Stanley Road, L20 3DL Bootle, UK
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Dalton ARH, Bottle A, Soljak M, Majeed A, Millett C. Ethnic group differences in cardiovascular risk assessment scores: national cross-sectional study. ETHNICITY & HEALTH 2014; 19:367-384. [PMID: 23663041 DOI: 10.1080/13557858.2013.797568] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES There are marked inequalities in cardiovascular disease (CVD) incidence and outcomes between ethnic groups. CVD risk scores are increasingly used in preventive medicine and should aim to accurately reflect differences between ethnic groups. Ethnicity, as an independent risk factor for CVD, can be accounted for in CVD risk scores primarily using two methods, either directly incorporating it as a risk factor in the algorithm or through a post hoc adjustment of risk. We aim to compare these two methods in terms of their prediction of CVD across ethnic groups using representative national data from England. DESIGN A cross-sectional study using data from the Health Survey for England. We measured ethnic group differences in risk estimation between the QRISK2, which includes ethnicity and Joint British Societies 2 (JBS2) algorithm, which uses post hoc risk adjustment factor for South Asian men. RESULTS The QRISK2 score produces lower median estimates of CVD risk than JBS2 overall (6.6% [lower quartile-upper quartile (LQ-UQ)=4.0-18.6] compared with 9.3% [LQ-UQ=2.3-16.9]). Differences in median risk scores are significantly greater in South Asian men (7.5% [LQ-UQ=3.6-12.5]) compared with White men (3.0% [LQ-UQ=0.7-5.9]). Using QRISK2, 19.1% [95% confidence interval (CI)=16.2-22.0] fewer South Asian men are designated at high risk compared with 8.8% (95% CI=5.9-7.8) fewer in White men. Across all ethnic groups, women had a lower median QRISK2 score (0.72 [LQ-UQ=- 0.6 to 2.13]), although relatively more (2.0% [95% CI=1.4-2.6]) were at high risk than with JBS2. CONCLUSIONS Ethnicity is an important CVD risk factor. Current scoring tools used in the UK produce significantly different estimates of CVD risk within ethnic groups, particularly in South Asian men. Work to accurately estimate CVD risk in ethnic minority groups is important if CVD prevention programmes are to address health inequalities.
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Affiliation(s)
- Andrew R H Dalton
- a Department of Primary Care Health Sciences , University of Oxford , Oxford , UK
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Hausärztliche Prävention zwischen Evidenz und Narration - Eine Quadratur des Kreises? ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:203-7. [DOI: 10.1016/j.zefq.2014.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/28/2014] [Accepted: 03/21/2014] [Indexed: 11/18/2022]
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