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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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Nichol BAB, Hurlbert AC, Read JCA. Predicting attitudes towards screening for neurodegenerative diseases using OCT and artificial intelligence: Findings from a literature review. J Public Health Res 2022; 11:22799036221127627. [PMID: 36310821 PMCID: PMC9597051 DOI: 10.1177/22799036221127627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Recent developments in artificial intelligence (AI) and machine learning raise the possibility of screening and early diagnosis for neurodegenerative diseases, using 3D scans of the retina. The eventual value of such screening will depend not only on scientific metrics such as specificity and sensitivity but, critically, also on public attitudes and uptake. Differential screening rates for various screening programmes in England indicate that multiple factors influence uptake. In this narrative literature review, some of these potential factors are explored in relation to predicting uptake of an early screening tool for neurodegenerative diseases using AI. These include: awareness of the disease, perceived risk, social influence, the use of AI, previous screening experience, socioeconomic status, health literacy, uncontrollable mortality risk, and demographic factors. The review finds the strongest and most consistent predictors to be ethnicity, social influence, the use of AI, and previous screening experience. Furthermore, it is likely that factors also interact to predict the uptake of such a tool. However, further experimental work is needed both to validate these predictions and explore interactions between the significant predictors.
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Affiliation(s)
- Beth AB Nichol
- Department of Social Work, Education,
and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK,Beth AB Nichol, Department of Social Work,
Education, and Community Wellbeing, Northumbria University, Coach Lane,
Newcastle upon Tyne NE7 7XA, UK.
| | - Anya C Hurlbert
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
| | - Jenny CA Read
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
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3
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Sallis A, Gold N, Agbebiyi A, James RJE, Berry D, Bonus A, Vlaev I, Chadborn T. Increasing uptake of National Health Service Health Checks in primary care: a pragmatic randomized controlled trial of enhanced invitation letters in Northamptonshire, England. J Public Health (Oxf) 2021; 43:e92-e99. [PMID: 31840739 DOI: 10.1093/pubmed/fdz134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Uptake of NHS Health Checks (NHSHCs) is sub-optimal. This study aimed to increase their uptake using behaviourally informed invitation letters. METHOD Patients registered with 6 general practices in Northamptonshire, England who were eligible for an NHSHC between 10 February 2014 and 31 January 2015 were randomized monthly, using a random number generator, to three trial arms: control (standard invitation), sunk costs (resources already allocated) and counterargument (against common barriers to attendance). The outcome measure was uptake of NHSHC by 12 weeks after 31 January. RESULTS In total, 6331 patients were randomized. After exclusions, due to ineligibility for the NHSHC, data were analysed for N = 6313 patients: N = 2123 control; N = 2085 counterargument; N = 2105 sunk costs. Overall, 2364 (37.45%) patients attended an NHSHC. Both intervention letters increased uptake compared to control, by 5.46% using counterargument (adjusted odds ratio (AOR) 1.32, CI 1.162-1.51, p < 0.001) and 4.33% using sunk costs (AOR 1.246, CI 1.10-1.42, p < 0.001), with no significant difference between the two. CONCLUSION Behaviourally informed invitation letters, containing sunk costs or counterargument messages, can improve the uptake of NHSHCs. The trial was registered with the International Standard Randomised Controlled Trial Registration Number Scheme (ISRCTN57110614).
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Affiliation(s)
- A Sallis
- Public Health England Behavioural Insights, Public Health England, London, UK
| | - N Gold
- Public Health England Behavioural Insights, Public Health England, London, UK.,Faculty of Philosophy, University of Oxford, Oxford, UK
| | - A Agbebiyi
- Public Health England Behavioural Insights, Public Health England, London, UK
| | - R J E James
- School of Psychology, University of Nottingham, Nottingham, UK
| | - D Berry
- Department of Health and Social Care, London, UK
| | - A Bonus
- Department of Health and Social Care, London, UK
| | - I Vlaev
- Behavioural Science Group, Warwick Business School, Coventry, UK
| | - T Chadborn
- Public Health England Behavioural Insights, Public Health England, London, UK
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Hasanah IJ, Hadi EN, Setio KAD. Determinants of the Utilization of a Noncommunicable Disease Screening Service by White Collar Workers in Depok City, West Java Indonesia. Int J Prev Med 2020; 11:198. [PMID: 33815722 PMCID: PMC8000174 DOI: 10.4103/ijpvm.ijpvm_59_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/02/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Noncommunicable disease (NCD) screening provides a means for early detection of chronic diseases, thereby reducing the risks posed by NCDs. In 2012, 56 million deaths were reported globally, 38 million of which were attributed to NCDs. In Indonesia, NCDs are a major cause of mortality. In Depok City, an NCD screening program among white collar employees has been in place since 2016. This study aimed to establish the determinants of NCD screening among workers at the Depok City Hall. METHODS The study used quantitative methods and a cross-sectional study design. It was conducted at Depok City Hall, Depok City, West Java, Indonesia. Data were collected using a self-reported questionnaire, which was pretested for validity and reliability. Data were analyzed using multiple logistic regressions. RESULTS Only 45.7% of workers had used the NCD screening service. Peer support (P < 0.01) and having pre-existing NCDs (P < 0.05) were the determinants of NCD screening among respondents. Peer support was the dominant factor associated with the utilization of NCD screening. After controlling for having NCDs, workers with adequate peer support had increased odds of uptake of NCD screening by more than two times (OR: 2.37, 95% CI: 1.29-4.37). CONCLUSIONS Peer support is important in persuading workers to utilize NCD screening. Therefore, it is necessary to develop health promotion programs in the workplace and to empower peer educators to encourage their colleagues to undertake regular health screening.
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Affiliation(s)
- Indah Jamiatun Hasanah
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Indonesia
| | - Ella Nurlaela Hadi
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Indonesia
| | - Kartika Anggun Dimar Setio
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Indonesia
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Badenbroek IF, Nielen MMJ, Hollander M, Stol DM, Kraaijenhagen RA, de Wit NJ, Schellevis FG. Feasibility and success rates of response enhancing strategies in a stepwise prevention program for cardiometabolic diseases in primary care. BMC FAMILY PRACTICE 2020; 21:228. [PMID: 33158419 PMCID: PMC7648376 DOI: 10.1186/s12875-020-01293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
Background Prevention programs for cardiometabolic diseases (CMD), including cardiovascular disease, diabetes mellitus and chronic kidney disease are feasible, but evidence for the cost-effectiveness of selective CMD prevention programs is lacking. Response rates have an important role in effectiveness, but methods to increase response rates have received insufficient attention. The aim of the current study is to determine the feasibility and the success rate of a variety of response enhancing strategies to increase the participation in a selective prevention program for CMD. Methods The INTEGRATE study is a Dutch randomised controlled trial to assess the effectiveness and cost-effectiveness of a stepwise program for CMD prevention. During the INTEGRATE study we developed ten different response enhancing strategies targeted at different stages of non-response and different patient populations and evaluated these in 29 general practices. Results A face-to-face reminder by the GP increased the response significantly. Digital reminders targeted at patients with an increased CMD risk showed a positive trend towards participation. Sending invitations and reminders by e-mail generated similar response rates, but at lower costs and time investment than the standard way of dissemination. Translated materials, information gatherings at the practice, self-management toolkits, reminders by telephone, information letters, local media attention and SMS text reminders did not increase the response to our program. Conclusions Inviting or reminding patients by e-mail or during GPs consultation may enhance response rates in a selective prevention program for CMD. Different response-enhancing strategies have different patient target populations and implementation issues, therefore practice characteristics need to be taken into account when implementing such strategies. Trial registration Dutch trial Register number NTR4277. Registered 26 November 2013. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12875-020-01293-9.
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Affiliation(s)
- Ilse F Badenbroek
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands. .,JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.
| | - Marcus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands
| | - Monika Hollander
- JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - Daphne M Stol
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands.,JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - Roderik A Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Naritaweg 70, 1043, BZ, Amsterdam, The Netherlands
| | - Niek J de Wit
- JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - François G Schellevis
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands.,Department of General Practice & Elderly Care Medicine, EMGO Institute for health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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Patel R, Barnard S, Thompson K, Lagord C, Clegg E, Worrall R, Evans T, Carter S, Flowers J, Roberts D, Nuttall M, Samani NJ, Robson J, Kearney M, Deanfield J, Waterall J. Evaluation of the uptake and delivery of the NHS Health Check programme in England, using primary care data from 9.5 million people: a cross-sectional study. BMJ Open 2020; 10:e042963. [PMID: 33154064 PMCID: PMC7646358 DOI: 10.1136/bmjopen-2020-042963] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To describe the uptake and outputs of the National Health Service Health Check (NHSHC) programme in England. DESIGN Observational study. SETTING National primary care data extracted directly by NHS Digital from 90% of general practices (GP) in England. PARTICIPANTS Individuals aged 40-74 years, invited to or completing a NHSHC between 2012 and 2017, defined using primary care Read codes. INTERVENTION The NHSHC, a structured assessment of non-communicable disease risk factors and 10-year cardiovascular disease (CVD) risk, with recommendations for behavioural change support and therapeutic interventions. RESULTS During the 5-year cycle, 9 694 979 individuals were offered an NHSHC and 5 102 758 (52.6%) took up the offer. There was geographical variation in uptake between local authorities across England ranging from 25.1% to 84.7%. Invitation methods changed over time to incorporate greater digitalisation, opportunistic delivery and delivery by third-party providers.The population offered an NHSHC resembled the English population in ethnicity and deprivation characteristics. Attendees were more likely to be older and women, but were similar in terms of ethnicity and deprivation, compared with non-attendees. Among attendees, risk factor prevalence reflected population survey estimates for England. Where a CVD risk score was documented, 25.9% had a 10-year CVD risk ≥10%, of which 20.3% were prescribed a statin. Advice, information and referrals were coded as delivered to over 2.5 million individuals identified to have risk factors. CONCLUSION This national analysis of the NHSHC programme, using primary care data from over 9.5 million individuals offered a check, reveals an uptake rate of over 50% and no significant evidence of inequity by ethnicity or deprivation. To maximise the anticipated value of the NHSHC, we suggest continued action is needed to invite more eligible people for a check, reduce geographical variation in uptake, prioritise engagement with non-attendees and promote greater use of evidence-based interventions especially where risk is identified.
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Affiliation(s)
- Riyaz Patel
- Institute of Cardiovascular Science, University College London, London, UK
| | | | | | | | | | | | | | | | | | | | | | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - John Deanfield
- Institute of Cardiovascular Science, University College London, London, UK
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Badenbroek IF, Nielen MMJ, Hollander M, Stol DM, Drijkoningen AE, Kraaijenhagen RA, de Wit NJ, Schellevis FG. Mapping non-response in a prevention program for cardiometabolic diseases in primary care: How to improve participation? Prev Med Rep 2020; 19:101092. [PMID: 32461878 PMCID: PMC7240717 DOI: 10.1016/j.pmedr.2020.101092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/15/2020] [Accepted: 04/04/2020] [Indexed: 11/18/2022] Open
Abstract
Non-response in prevention programs for CMD in primary care is often overlooked. Willingness to participate amongst non-responders is high. There are response enhancing strategies that show potential. We should be able to boost response rates of prevention programs for CMD. A next logical step is to test potential response enhancing strategies.
Non-response in prevention programs for cardiometabolic diseases (CMD) in primary care is often overlooked. The aim for this study was to define factors that influence the primary response to a selective CMD prevention program and to determine response-enhancing strategies that influence the willingness to participate. We conducted a non-response analysis within a randomized controlled trial evaluating a selective CMD prevention program, the study was conducted from 2013 to 2018 in Netherlands. A random sample of 5616 patients from 15 general practices were invited to complete a risk score (RS) as initial step of the program. Non-responders received an additional questionnaire. The response on the risk score was 51% (n = 2872). From the 3558 non-response questionnaires sent, 786 (22%) were returned. In a multivariable multilevel regression analysis smoking was independently associated with non-response. Of all reported reasons for non-response ‘forgot/no time’ accounted for 45%. In total, 73% of the non-responders indicated to reconsider participation when approached differently. A personal approach by the patients’ own GP, using advertisements and informative campaigns are potentially the best methods to enhance the response. Although a relatively high proportion did not respond to the invitation for the risk score, the majority of them indicated to be willing to participate if a different invitation strategy would be used. With more time and energy, response rates for CMD prevention programs could possibly increase substantially. A next logical step in this process is to test potential response enhancing strategies in research setting.
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Affiliation(s)
- Ilse F Badenbroek
- Julius Center, University Medical Center Utrecht, P.O. Box 85060, 3508 AB Utrecht, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), The Netherlands
| | - Marcus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), The Netherlands
| | - Monika Hollander
- Julius Center, University Medical Center Utrecht, P.O. Box 85060, 3508 AB Utrecht, The Netherlands
| | - Daphne M Stol
- Julius Center, University Medical Center Utrecht, P.O. Box 85060, 3508 AB Utrecht, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), The Netherlands
| | | | | | - Niek J de Wit
- Julius Center, University Medical Center Utrecht, P.O. Box 85060, 3508 AB Utrecht, The Netherlands
| | - François G Schellevis
- Netherlands Institute for Health Services Research (NIVEL), The Netherlands.,Department of General Practice & Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Bunten A, Porter L, Gold N, Bogle V. A systematic review of factors influencing NHS health check uptake: invitation methods, patient characteristics, and the impact of interventions. BMC Public Health 2020; 20:93. [PMID: 31964366 PMCID: PMC6975079 DOI: 10.1186/s12889-019-7889-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background The NHS Health Check (NHSHC) is a risk assessment for those aged 40–74 without a pre-existing condition in England, with the aim of preventing stroke, kidney disease, heart disease, type 2 diabetes and dementia. Uptake has been lower than anticipated. Ensuring that a high percentage of eligible patients receive a NHSHC is key to optimising the clinical and cost effectiveness of the programme. The aim of this systematic review is to highlight interventions and invitation methods that increase the uptake of NHSHCs, and to identify whether the effectiveness of these interact with broader patient and contextual factors. Method A systematic review was conducted according to the PRISMA checklist. Papers were eligible if they explored the impact of at least one of (i) interventions, (ii) invitation methods or (iii) broader factors on NHSHC uptake. Ten databases were searched in January 2016 and seven were searched in March 2018. Nine-hundred-and-forty-five papers were identified, 238 were screened and 64 full texts were assessed for eligibility. Nine studies were included in the review. Results The nine studies were all from peer reviewed journals. They included two randomised controlled trials, one observational cohort and six cross-sectional studies. Different invitation methods may be more effective for different groups of patients based on their ethnicity and gender. One intervention to enhance invitation letters effectively increased uptake but another did not. In addition, individual patient characteristics (such as age, gender, ethnicity and risk level) were found to influence uptake. This review also finds that uptake varies significantly by GP practice, which could be due either to unidentified practice-level factors or deprivation. Conclusions Further research is needed to assess the effectiveness of different invitation methods for different population groups. Research should examine how existing invitation methods can be enhanced to drive uptake whilst reducing health inequalities. Trial registration This systematic review was registered with PROSPERO on 22.02.2016. Registration number CRD42016035626.
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Affiliation(s)
- Amanda Bunten
- Public Health England, PHE Behavioural Insights Team (PHEBI), Research, Translation & Innovation Division, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.
| | - Lucy Porter
- Public Health England, PHE Behavioural Insights Team (PHEBI), Research, Translation & Innovation Division, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.,University of Exeter, Exeter, UK
| | - Natalie Gold
- Public Health England, PHE Behavioural Insights Team (PHEBI), Research, Translation & Innovation Division, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
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Whittaker PJ. Uptake of cardiovascular health checks in community pharmacy versus general practice. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paula J. Whittaker
- Division of Population Health Health Services Research and Primary Care School of Health Sciences University of Manchester Manchester 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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11
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Sallis A, Sherlock J, Bonus A, Saei A, Gold N, Vlaev I, Chadborn T. Pre-notification and reminder SMS text messages with behaviourally informed invitation letters to improve uptake of NHS Health Checks: a factorial randomised controlled trial. BMC Public Health 2019; 19:1162. [PMID: 31438908 PMCID: PMC6706889 DOI: 10.1186/s12889-019-7476-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake. METHODS We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMS - yes or no) × 4 (letter - national template control, open-ended, time-limited, social norm) × 2 (reminder SMS - yes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC. RESULTS Data for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder (Uptake 30%; Adjusted Odds Ratio AOR 1.86; 95% CI 1.45-2.83; p < 0.00); 10 percentage points for the open-ended letter with reminder (Uptake 27%; AOR 1.68; 95% CI 1.31-2.17; p < 0.00) and a 9 percentage point increase using the time-limited letter with reminder (Uptake 27%; AOR 1.61; 95% CI 1.25-2.10; p < 0.00). The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect. CONCLUSIONS This large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance. TRIAL REGISTRATION Retrospectively Registered (24/01/2014) ISRCTN36027094 .
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Affiliation(s)
- Anna Sallis
- PHE Behavioural Insights, Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG UK
| | - Joseph Sherlock
- Center for Advanced Hindsight, Social Science Research Institute, Duke University, 334 Blackwell Street, Suite 320, Durham, North Carolina 27701 USA
- HMRC, 100 Parliament Street, London, SW1A 2BQ England
| | | | - Ayoub Saei
- PHE Statistics, Modelling and Economics Department, Public Health England, Colindale Avenue Site, 61 Colindale Avenue, London, NW9 5EQ UK
| | - Natalie Gold
- PHE Behavioural Insights, Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG UK
- Faculty of Philosophy, Radcliffe Observatory Quarter 555, Woodstock Road, Oxford, OX2 6GG England
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, CV4 7AL UK
| | - Tim Chadborn
- PHE Behavioural Insights, Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG UK
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12
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Larsen LB, Sondergaard J, Thomsen JL, Halling A, Sønderlund AL, Christensen JR, Thilsing T. Step-wise approach to prevention of chronic diseases in the Danish primary care sector with the use of a personal digital health profile and targeted follow-up - an assessment of attendance. BMC Public Health 2019; 19:1092. [PMID: 31409343 PMCID: PMC6693260 DOI: 10.1186/s12889-019-7419-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 07/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background Current evidence on chronic disease prevention suggests that interventions targeted at high-risk individuals represents the best way forward. We implemented a step-wise approach in the Danish primary care sector, designed for the systematic and targeted prevention of chronic disease. The intervention centered on a personal digital health profile for all participants, followed by targeted preventive programs for high-risk patients. The present paper examines individual characteristics and health-care usage of patients who took up the targeted preventive programs in response to their personal digital health profile. Methods A sample of patients born between 1957 and 1986 was randomly selected from the patient-list system of participating general practitioners in two Danish municipalities. The selected patients received a digital invitation to participate. Consenting patients received a second digital invitation for a personal digital health profile based on questionnaire and electronic patient record data. The personal digital health profile contained individualized information on risk profile and personalized recommendations on further actions. If at-risk or presenting with health-risk behaviour a patient would be advised to contact either their general practitioner or municipal health centre for targeted preventive programs. Attendance at the targeted preventive programs was examined using Poisson regression and chi-squared automatic interaction detection methods. Results A total of 9400 patients were invited. Of those who participated (30%), 22% were advised to get a health check at their general practitioner. Of these, 19% did so. Another 23% were advised to schedule an appointment for behaviour-change counselling at their municipal health centre. A total of 21% took the advice. Patients who had fair or poor self-rated health, a body mass index above 30, low self-efficacy, were female, non-smokers, or lead a sedentary lifestyle, were most likely to attend the targeted preventive programs. Conclusions A personal digital health profile shows some promise in a step-wise approach to prevention in the Danish primary care sector and seems to motivate people with low self-efficacy to attend targeted preventive programs. Trial registration Registered at Clinical Trial Gov (Unique Protocol ID: TOFpilot2016). Prospectively registered on the 29th of April 2016.
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Affiliation(s)
- Lars Bruun Larsen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark.
| | - Jens Sondergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Janus Laust Thomsen
- Department of Clinical Medicine, Research Unit for General Practice, Aalborg University, Aalborg, Denmark
| | - Anders Halling
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Anders Larrabee Sønderlund
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Trine Thilsing
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark
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13
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Gidlow CJ, Ellis NJ, Riley V, Chadborn T, Bunten A, Iqbal Z, Ahmed A, Fisher A, Sugden D, Clark-Carter D. Randomised controlled trial comparing uptake of NHS Health Check in response to standard letters, risk-personalised letters and telephone invitations. BMC Public Health 2019; 19:224. [PMID: 30791884 PMCID: PMC6385450 DOI: 10.1186/s12889-019-6540-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 02/13/2019] [Indexed: 12/22/2022] Open
Abstract
Background NHS Health Check is a primary prevention programme offering cardiovascular disease (CVD) risk assessment to adults in England aged 40–74. Uptake remains a challenge and invitation method is a strong predictor of uptake. There is evidence of low uptake when using invitation letters. Telephone invitations might increase uptake, but are not widely used. We explored the potential to improve uptake through personalising letters to patient’s CVD risk, and to compare this with generic letters and telephone invitations. Methods HEalth Check TRial (HECTR) was a three-arm randomised controlled trial in nine general practices in Staffordshire (UK). Eligible patients were randomised to be invited to a NHS Health Check using one of three methods: standard letter (control); telephone invitation; letter personalised to the patient’s CVD risk. The primary outcome was attendance/non-attendance. Data were collected on a range of patient- and practice-level factors (e.g., patient socio-demographics, CVD risk, practice size, Health Checks outside usual working hours). Multi-level logistic regression estimated the marginal effects to explore whether invitation method predicted attendance. Invitation costs were collated from practices to estimate cost benefit. Results In total, 4614 patients were included in analysis (mean age 50.2 ± 8.0 yr.; 52.4% female). Compared with patients invited by standard letter (30.9%), uptake was significantly higher in those invited by telephone (47.6%, P < .001), but not personalised letter (31.3%, p = .812). In multi-level analysis, compared with the standard letter arm, likelihood of attendance was 18 percentage points higher in the telephone arm and 4 percentage points higher in the personalised letter arm. The effect of telephone calls appeared strongest in patients who were younger and had lower CVD risk. We estimated per 1000 patients invited, risk-personalised letters could result in 40 additional attended Health Checks (at no extra cost) and telephone invitations could result in 180 additional Health Checks at an additional cost of £240. Conclusions Telephone invitations should be advocated to address the substantial deficit between current and required levels of NHS uptake, and could be targeted at younger and lower CVD risk adults. Risk-personalised letters should be explored further in a larger sample of high risk individuals. Trial registration Registration number: ISRCTN15840751 date of registration: 24/10/2017. Electronic supplementary material The online version of this article (10.1186/s12889-019-6540-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development (CHAD), Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF, England.
| | - Naomi J Ellis
- Centre for Health and Development (CHAD), Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF, England
| | - Victoria Riley
- Centre for Health and Development (CHAD), Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF, England
| | - Tim Chadborn
- Public Health England, Skipton House, 80 London Road, London, SE1 6LH, England
| | - Amanda Bunten
- Public Health England, Skipton House, 80 London Road, London, SE1 6LH, England
| | - Zafar Iqbal
- Midlands Partnership NHS Foundation Trust, St George's Hospital, Corporation Street, Stafford, ST16 3AG, England
| | - Aliko Ahmed
- Public Health England East of England, Victoria House, Capital Park, Fulbourn, Cambridge, CB21 5XA, England
| | - Alistair Fisher
- Stoke-on-Trent City Council, Glebe Street, Stoke-on-Trent, ST4 1HH, England
| | - David Sugden
- Staffordshire County Council, 1 Staffordshire Place, Stafford, ST16 2LP, England
| | - David Clark-Carter
- Centre for Psychological Research, Staffordshire University, The Science Centre, Leek Road, Stoke-on-Trent, ST4 2DF, England
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14
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Local authority commissioning of NHS Health Checks: A regression analysis of the first three years. Health Policy 2018; 122:1035-1042. [PMID: 30055899 DOI: 10.1016/j.healthpol.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 05/24/2018] [Accepted: 07/12/2018] [Indexed: 11/21/2022]
Abstract
In April 2013, the public health function was transferred from the NHS to local government, making local authorities (LAs) responsible for commissioning the NHS Health Check programme. The programme aims to reduce preventable mortality and morbidity in people aged 40-74. The national five-year ambition is to invite all eligible individuals and to achieve an uptake of 75%. This study evaluates the effects of LA expenditure on the programme's invitation rates (the proportion of the eligible population invited to a health check), coverage rates (the proportion of the eligible population who received a health check) and uptake rates (attendance by those who received a formal invitation letter) in the first three years of the reforms. We ran negative binomial panel models and controlled for a range of confounders. Over 2013/14-2015/16, the invitation rate, coverage rate and uptake rate averaged 57% 28% and 49% respectively. Higher per capita spend on the programme was associated with increases in both the invitation rate and coverage rate, but had no effect on the uptake rate. When we controlled for the LA invitation rate, the association between spend and coverage rate was smaller but remained statistically significant. This suggests that alternatives to formal invitation, such as opportunistic approaches in work places or sports centres, may be effective in influencing attendance.
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15
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Martin A, Saunders CL, Harte E, Griffin SJ, MacLure C, Mant J, Meads C, Walter FM, Usher-Smith JA. Delivery and impact of the NHS Health Check in the first 8 years: a systematic review. Br J Gen Pract 2018; 68:e449-e459. [PMID: 29914882 PMCID: PMC6014431 DOI: 10.3399/bjgp18x697649] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/14/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Since 2009, all eligible persons in England have been entitled to an NHS Health Check. Uncertainty remains about who attends, and the health-related impacts. AIM To review quantitative evidence on coverage (the proportion of eligible individuals who attend), uptake (proportion of invitees who attend), and impact of NHS Health Checks. DESIGN AND SETTING A systematic review and quantitative data synthesis. Included were studies or data reporting coverage or uptake and studies reporting any health-related impact that used an appropriate comparison group or before- and-after study design. METHOD Eleven databases and additional internet sources were searched to November 2016. RESULTS Twenty-six observational studies and one additional dataset were included. Since 2013, 45.6% of eligible individuals have received a health check. Coverage is higher among older people, those with a family history of coronary heart disease, those living in the most deprived areas, and some ethnic minority groups. Just under half (48.2%) of those invited have taken up the invitation. Data on uptake and impact (especially regarding health-related behaviours) are limited. Uptake is higher in older people and females, but lower in those living in the most deprived areas. Attendance is associated with small increases in disease detection, decreases in modelled cardiovascular disease risk, and increased statin and antihypertensive prescribing. CONCLUSION Published attendance, uptake, and prescribing rates are all lower than originally anticipated, and data on impact are limited, with very few studies reporting the effect of attendance on health-related behaviours. High-quality studies comparing matched attendees and non-attendees and health economic analyses are required.
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Affiliation(s)
- Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, and RAND Europe, Cambridge
| | - Catherine L Saunders
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, and RAND Europe, Cambridge
| | | | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, and Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge
| | | | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Catherine Meads
- RAND Europe, and Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
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16
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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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17
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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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18
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McDermott L, Wright AJ, Cornelius V, Burgess C, Forster AS, Ashworth M, Khoshaba B, Clery P, Fuller F, Miller J, Dodhia H, Rudisill C, Conner MT, Gulliford MC. Enhanced invitation methods and uptake of health checks in primary care: randomised controlled trial and cohort study using electronic health records. Health Technol Assess 2018; 20:1-92. [PMID: 27846927 DOI: 10.3310/hta20840] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A national programme of health checks to identify risk of cardiovascular disease (CVD) is being rolled out but is encountering difficulties because of low uptake. OBJECTIVE To evaluate the effectiveness of an enhanced invitation method using the question-behaviour effect (QBE), with or without the offer of a financial incentive to return the QBE questionnaire, at increasing the uptake of health checks. The research went on to evaluate the reasons for the low uptake of invitations and compare the case mix for invited and opportunistic health checks. DESIGN Three-arm randomised trial and cohort study. PARTICIPANTS All participants invited for a health check from 18 general practices. Individual participants were randomised. INTERVENTIONS (1) Standard health check invitation only; (2) QBE questionnaire followed by a standard invitation; and (3) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by a standard invitation. MAIN OUTCOME MEASURES The primary outcome was completion of the health check within 6 months of invitation. A p-value of 0.0167 was used for significance. In the cohort study of all health checks completed during the study period, the case mix was compared for participants responding to invitations and those receiving 'opportunistic' health checks. Participants were not aware that several types of invitation were in use. The research team were blind to trial arm allocation at outcome data extraction. RESULTS In total, 12,459 participants were included in the trial and health check uptake was evaluated for 12,052 participants for whom outcome data were collected. Health check uptake was as follows: standard invitation, 590 out of 4095 (14.41%); QBE questionnaire, 630 out of 3988 (15.80%); QBE questionnaire and financial incentive, 629 out of 3969 (15.85%). The increase in uptake associated with the QBE questionnaire was 1.43% [95% confidence interval (CI) -0.12% to 2.97%; p = 0.070] and the increase in uptake associated with the QBE questionnaire and offer of financial incentive was 1.52% (95% CI -0.03% to 3.07%; p = 0.054). The difference in uptake associated with the offer of an incentive to return the QBE questionnaire was -0.01% (95% CI -1.59% to 1.58%; p = 0.995). During the study period, 58% of health check cardiovascular risk assessments did not follow a trial invitation. People who received an 'opportunistic' health check had greater odds of a ≥ 10% CVD risk than those who received an invited health check (adjusted odds ratio 1.70, 95% CI 1.45 to 1.99; p < 0.001). CONCLUSIONS Uptake of a health check following an invitation letter is low and is not increased through an enhanced invitation method using the QBE. The offer of a £5 incentive did not increase the rate of return of the QBE questionnaire. A high proportion of all health checks are performed opportunistically and not in response to a standard invitation letter. Participants receiving opportunistic checks are at higher risk of CVD than those responding to standard invitations. Future research should aim to increase the accessibility of preventative medical interventions to increase uptake. Research should also explore the wider use of electronic health records in delivering efficient trials. TRIAL REGISTRATION Current Controlled Trials ISRCTN42856343. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 84. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lisa McDermott
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Victoria Cornelius
- 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
| | - Alice S Forster
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Bernadette Khoshaba
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Philippa Clery
- Department of Primary Care and Public Health Sciences, King's College London, 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
| | - Caroline Rudisill
- Department of Social Policy, London School of Economics and Political Science, 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, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' Hospitals, Guy's Hospital, London, UK
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Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis. Br J Gen Pract 2017; 68:e28-e35. [PMID: 29203682 PMCID: PMC5737317 DOI: 10.3399/bjgp17x693929] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022] Open
Abstract
Background The NHS Health Check programme is a prevention initiative offering cardiovascular risk assessment and management advice to adults aged 40–74 years across England. Its effectiveness depends on uptake. When it was introduced in 2009, it was anticipated that all those eligible would be invited over a 5-year cycle and 75% of those invited would attend. So far in the current cycle from 2013 to 2018, 33.8% of those eligible have attended, which is equal to 48.5% of those invited to attend. Understanding the reasons why some people do not attend is important to maximise the impact of the programmes. Aim To review why people do not attend NHS Health Checks. Design and setting A systematic review and thematic synthesis of qualitative studies. Method An electronic literature search was carried out of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index to Nursing and Allied Health Literature, Global Health, PsycINFO, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov, and the ISRCTN registry from 1 January 1996 to 9 November 2016, and the reference lists of all included papers were also screened manually. Inclusion criteria were primary research studies that reported the views of people who were eligible for but had not attended an NHS Health Check. Results Nine studies met the inclusion criteria. Reasons for not attending included lack of awareness or knowledge, misunderstanding the purpose of the NHS Health Check, aversion to preventive medicine, time constraints, difficulties with access to general practices, and doubts regarding pharmacies as appropriate settings. Conclusion The findings particularly highlight the need for improved communication and publicity around the purpose of the NHS Health Check programme and the personal health benefits of risk factor detection.
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Breeze PR, Thomas C, Squires H, Brennan A, Greaves C, Diggle P, Brunner E, Tabak A, Preston L, Chilcott J. Cost-effectiveness of population-based, community, workplace and individual policies for diabetes prevention in the UK. Diabet Med 2017; 34:1136-1144. [PMID: 28294392 PMCID: PMC5573930 DOI: 10.1111/dme.13349] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 12/28/2022]
Abstract
AIM To analyse the cost-effectiveness of different interventions for Type 2 diabetes prevention within a common framework. METHODS A micro-simulation model was developed to evaluate the cost-effectiveness of a range of diabetes prevention interventions including: (1) soft drinks taxation; (2) retail policy in socially deprived areas; (3) workplace intervention; (4) community-based intervention; and (5) screening and intensive lifestyle intervention in individuals with high diabetes risk. Within the model, individuals follow metabolic trajectories (for BMI, cholesterol, systolic blood pressure and glycaemia); individuals may develop diabetes, and some may exhibit complications of diabetes and related disorders, including cardiovascular disease, and eventually die. Lifetime healthcare costs, employment costs and quality-adjusted life-years are collected for each person. RESULTS All interventions generate more life-years and lifetime quality-adjusted life-years and reduce healthcare spending compared with doing nothing. Screening and intensive lifestyle intervention generates greatest lifetime net benefit (£37) but is costly to implement. In comparison, soft drinks taxation or retail policy generate lower net benefit (£11 and £11) but are cost-saving in a shorter time period, preferentially benefit individuals from deprived backgrounds and reduce employer costs. CONCLUSION The model enables a wide range of diabetes prevention interventions to be evaluated according to cost-effectiveness, employment and equity impacts over the short and long term, allowing decision-makers to prioritize policies that maximize the expected benefits, as well as fulfilling other policy targets, such as addressing social inequalities.
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Affiliation(s)
- P. R. Breeze
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - C. Thomas
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - H. Squires
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - A. Brennan
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - C. Greaves
- University of Exeter Medical SchoolUniversity of ExeterExeter
| | - P. Diggle
- Medical SchoolLancaster UniversityLancaster
- Institute of Infection and Global HealthUniversity of LiverpoolLiverpool
| | - E. Brunner
- Epidemiology and Public HealthUniversity College LondonLondonUK
| | - A. Tabak
- Epidemiology and Public HealthUniversity College LondonLondonUK
- First Department of MedicineSemmelweis University Faculty of MedicineBudapestHungary
| | - L. Preston
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - J. Chilcott
- School of Health and Related ResearchUniversity of SheffieldSheffield
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Woringer M, Cecil E, Watt H, Chang K, Hamid F, Khunti K, Dubois E, Evason J, Majeed A, Soljak M. Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study. BMC Health Serv Res 2017; 17:405. [PMID: 28615019 PMCID: PMC5471843 DOI: 10.1186/s12913-017-2346-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/31/2017] [Indexed: 11/14/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England’s National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. Methods Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. Results Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p < 0.05) than the general population. Screened populations in 29 of 38 LAs were significantly more deprived (p < 0.05). No statistically significant difference among ethnic minority groups was observed between LAs. Nonetheless some LAs – namely Leicester, Thurrock, Sutton, South Tyneside, Portsmouth and Gateshead were very successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p < 0.001) and mean proportion of 40–49 and 50–59 year olds was 9.98% and 3.58% higher (p < 0.0001 and p < 0.01 respectively) than the general population across 38 LAs. Conclusions Community-based outreach providers effectively reach under-served groups by delivering preventive CVD services to younger, more deprived populations, and a representative proportion of ethnic minority groups. If the programme is successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein.
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Affiliation(s)
- Maria Woringer
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
| | - Elizabeth Cecil
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Hillary Watt
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Kiara Chang
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Fozia Hamid
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester, LE5 4PW, UK
| | - Elizabeth Dubois
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Julie Evason
- Health Diagnostics Ltd., Suite C, The Quadrant,, Sealand Road,, Chester, CH1 4QR, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Michael Soljak
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
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22
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Bjerregaard AL, Maindal HT, Bruun NH, Sandbæk A. Patterns of attendance to health checks in a municipality setting: the Danish 'Check Your Health Preventive Program'. Prev Med Rep 2016; 5:175-182. [PMID: 28050340 PMCID: PMC5200886 DOI: 10.1016/j.pmedr.2016.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/22/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Anne-Louise Bjerregaard
- Section of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Corresponding author at: Section of General Practice, Department of Public Health, Bartholins Alle 2, DK-8000 Aarhus., Denmark.Section of General PracticeDepartment of Public HealthBartholins Alle 2AarhusDK-8000Denmark
| | - Helle T Maindal
- Steno Health Promotion Centre, Steno Diabetes Center A/S, Gentofte, Denmark
- Section of Health Promotion and Health Services, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Niels Henrik Bruun
- Section of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Annelli Sandbæk
- Section of General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit of General Practice, Aarhus University, Aarhus, Denmark
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23
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Nelson PA, Kane K, Chisholm A, Pearce CJ, Keyworth C, Rutter MK, Chew-Graham CA, Griffiths CEM, Cordingley L. 'I should have taken that further' - missed opportunities during cardiovascular risk assessment in patients with psoriasis in UK primary care settings: a mixed-methods study. Health Expect 2016; 19:1121-37. [PMID: 26340682 PMCID: PMC5053232 DOI: 10.1111/hex.12404] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle is common in psoriasis, contributing to worsening disease and increased cardiovascular disease (CVD) risk. CVD risk communication should improve patients' understanding of risk and risk-reducing behaviours; however, the effectiveness of risk screening is debated and evaluation currently limited. OBJECTIVE To examine the process of assessing for and communicating about CVD risk in the context of psoriasis. DESIGN Mixed-methods study in English general practices to (i) determine proportions of CVD risk factors among patients with psoriasis at risk assessment and (ii) examine patient and practitioner experiences of risk communication to identify salient 'process' issues. Audio recordings of consultations informed in-depth interviews with patients and practitioners using tape-assisted recall, analysed with framework analysis. PARTICIPANTS Patients with psoriasis (n = 287) undergoing CVD risk assessment; 29 patients and 12 practitioners interviewed. RESULTS A high proportion of patients had risk factor levels apparent at risk assessment above NICE recommendations: very high waist circumference (52%), obesity (35%), raised blood pressure (29%), smoking (18%) and excess alcohol consumption (18%). There was little evidence of personalized discussion about CVD risk and behaviour change support in consultations. Professionals reported a lack of training in behaviour change, while patients wanted to discuss CVD risk/risk reduction and believed practitioners to be influential in supporting lifestyle management. CONCLUSIONS Despite high levels of risk factors identified, opportunities may be missed in consultations to support patients with psoriasis to understand CVD risk/risk reduction. Practitioners need training in behaviour change techniques to capitalize on 'teachable moments' and increase the effectiveness of risk screening.
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Affiliation(s)
- Pauline A Nelson
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK.
| | - Karen Kane
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Anna Chisholm
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Dermatology and Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Christina J Pearce
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher Keyworth
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Martin K Rutter
- The Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- West Midlands CLAHRC, Keele, UK
| | - Christopher E M Griffiths
- Manchester Centre for Dermatology Research, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Lis Cordingley
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
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24
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Riley R, Coghill N, Montgomery A, Feder G, Horwood J. Experiences of patients and healthcare professionals of NHS cardiovascular health checks: a qualitative study. J Public Health (Oxf) 2016; 38:543-551. [PMID: 26408822 PMCID: PMC5072162 DOI: 10.1093/pubmed/fdv121] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND NHS Health Checks are a national cardiovascular risk assessment and management programme in England and Wales. We examined the experiences of patients attending and healthcare professionals (HCPs) conducting NHS Health Checks. METHODS Interviews were conducted with a purposive sample of 28 patients and 16 HCPs recruited from eight general practices across a range of socio-economic localities. Interviews were audio recorded, transcribed, anonymized and analysed thematically. RESULTS Patients were motivated to attend an NHS Health Check because of health beliefs, the perceived value of the programme, a family history of cardiovascular and other diseases and expectations of receiving a general health assessment. Some patients reported benefits including reassurance and reinforcement of healthy lifestyles. Others experienced confusion and frustration about how results and advice were communicated, some having a poor understanding of the implications of their results. HCPs raised concerns about the skill set of some staff to competently communicate risk and lifestyle information. CONCLUSIONS To improve the satisfaction of patients attending and improve facilitation of lifestyle change, HCPs conducting the NHS Health Checks require sufficient training to equip them with appropriate skills and knowledge to deliver the service effectively.
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Affiliation(s)
- R. Riley
- School of Social and Community Medicine, University of Bristol, BristolBS8 2PS, UK
| | - N. Coghill
- School of Social and Community Medicine, University of Bristol, BristolBS8 2PS, UK
| | - A. Montgomery
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK
| | - G. Feder
- School of Social and Community Medicine, University of Bristol, BristolBS8 2PS, UK
| | - J. Horwood
- School of Social and Community Medicine, University of Bristol, BristolBS8 2PS, UK
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25
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Attwood S, Morton K, Sutton S. Exploring equity in uptake of the NHS Health Check and a nested physical activity intervention trial. J Public Health (Oxf) 2016; 38:560-568. [PMID: 26036701 PMCID: PMC5072157 DOI: 10.1093/pubmed/fdv070] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Socio-demographic factors characterizing disadvantage may influence uptake of preventative health interventions such as the NHS Health Check and research trials informing their content. METHODS A cross-sectional study examining socio-demographic characteristics of participants and non-participants to the NHS Health Check and a nested trial of very brief physical activity interventions within this context. Age, gender, Index of Multiple Deprivation (IMD) and ethnicity were extracted from patient records of four General Practices (GP) in England. RESULTS In multivariate analyses controlling for GP surgery, the odds of participation in the Health Check were higher for older patients (OR 1.05, 95% CI 1.04-1.07) and lower from areas of greater deprivation (IMD Quintiles 4 versus 1, OR 0.37, 95% CI 0.18-0.76, 5 versus 1 OR 0.42, 95% CI 0.20-0.88). Older patients were more likely to participate in the physical activity trial (OR 1.04, 95% CI 1.02-1.06). CONCLUSIONS Younger patients and those living in areas of greater deprivation may be at risk of non-participation in the NHS Health Check, while younger age also predicted non-participation in a nested research trial. The role that GP-surgery-specific factors play in influencing participation across different socio-demographic groups requires further exploration.
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Affiliation(s)
- S Attwood
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - K Morton
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - S Sutton
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
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26
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Ware RS, Lennox NG. Characteristics influencing attendance at a primary care health check for people with intellectual disability: An individual participant data meta-analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:235-241. [PMID: 27148683 DOI: 10.1016/j.ridd.2016.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Health checks benefit adolescents and adults with intellectual disability, however uptake is low despite government-funded incentives. AIM To assess the characteristics of people with intellectual disability who, when offered a health check with their primary care physician at no cost, completed the health check. METHODS AND PROCEDURES Data from three randomised controlled trials considering health checks in people with intellectual disability living in the community were included in an individual-patient data meta-analysis. The studies used the same health check and the participant characteristics investigated (age, sex, cause of disability, level of disability and socio-economic position) were defined identically, but participants were sourced from different settings: adults living in 24-h supported accommodation, adults living in private dwellings, and school-attending adolescents. OUTCOMES AND RESULTS In total 715 participants were offered health checks. Compared to participants with Down syndrome, participants with other known causes of disability were more likely not to attend their health check (odds ratio;95%CI)=(2.5;1.4-4.7), as were participants with no known cause of disability (2.3;1.2-4.3). These associations remained significant after adjusting for potentially confounding variables. CONCLUSION AND IMPLICATION Down syndrome was the only characteristic positively associated with health check attendance across all study settings. Future research should focus on strategies to increase health check uptake in this population.
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Affiliation(s)
- Robert S Ware
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Herston Road, Herston, QLD 4006, Australia; School of Public Health, The University of Queensland, Herston Road, Herston, QLD 4006, Australia.
| | - Nicholas G Lennox
- Queensland Centre for Intellectual and Developmental Disability, MRI-UQ, The University of Queensland, Mater Hospital, Raymond Terrace, South Brisbane, QLD 4101, Australia
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27
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Petersen J, Benzeval M. Untreated hypertension in the UK household population - Who are missed by the general health checks? Prev Med Rep 2016; 4:81-6. [PMID: 27413665 PMCID: PMC4929142 DOI: 10.1016/j.pmedr.2016.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/16/2016] [Indexed: 10/31/2022] Open
Abstract
Hypertension is an age-related, long-term condition and a leading risk factor for premature death and disability worldwide. Due to its asymptomatic nature it can often be left undiagnosed. Long-term treatment is available, but blood pressure can also be reduced through health behaviour changes in weight control, smoking cessation, higher physical activity levels, reduced salt and alcohol intake, and healthful diets if discovered early. This paper investigates the prevalence and characteristics of those with untreated (compared to treated) hypertension who did not have a history of cardiovascular disease (CVD); a group who is in effect missed by general health checks. Untreated hypertension was studied in 8933 individuals aged 40-74 years representative of the UK household population, who were interviewed and underwent a physical health examination in their home, 2010-2012. The prevalence of untreated hypertension without a history of CVD was 7% for men, 2% for women, and 5% overall. Untreated hypertension was particularly high among the 55-64 year age group. Age and sex-adjusted analyses found strong positive associations with male gender, smoking, self-reported good-excellent health, full fat dairy preference, white bread preference, higher alcohol consumption, and living alone. Strong negative associations were found for possessing 5 + prescription drugs, statins or antiplatelets, being diagnosed with diabetes or possessing antidiabetics, and long-term limiting illness status. Notably, many reported their health as good to excellent. A fact which emphasises the importance of motivating individuals to take part in the general health checks for an asymptomatic condition such as hypertension.
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Affiliation(s)
- Jakob Petersen
- Institute for Social and Economic Research, University of Essex, Colchester CO4 3SQ, United Kingdom
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester CO4 3SQ, United Kingdom
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28
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Roberts DJ, de Souza VC. A venue-based analysis of the reach of a targeted outreach service to deliver opportunistic community NHS Health Checks to 'hard-to-reach' groups. Public Health 2016; 137:176-81. [PMID: 27062066 DOI: 10.1016/j.puhe.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/25/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Opportunistic outreach services have been commissioned to overcome potential barriers to uptake, by offering health checks in accessible community venues. This study aimed to evaluate the ability of an outreach health check service to reach key target groups: men, people of South Asian ethnicity and people from deprived areas. The comparator was the health check service provided by GP practices. One aim was to investigate whether the addition of an outreach service would result in a higher percentage of health checks being done for people from the target groups compared to a GP-based service alone. The second aim was to assess which types of venues used for outreach health checks were most effective in reaching these groups. STUDY DESIGN Evaluation of Public Health Programme with retrospective control group comparison. METHODS The percentages of completed health checks in men, people of South Asian ethnicity, and participants registered at general practices with lowest quintile area-level deprivation status were compared between all opportunistic community checks conducted by the Outreach Service over a ten month period and checks conducted in general practice in a partially-overlapping time period of the same financial year. For the venue-based comparison of Outreach Service checks, the number of checks per visit and percentage of checks in each target group were calculated for each venue. RESULTS Of 3849 Outreach Service checks, 38% were in men (compared to 50% of checks conducted in Primary Care), and 11% were in people of South Asian ethnicity (compared to 3% in Primary Care). 3558 Outreach check participants were registered with a general practice in the County (92%), and of these, 32% of checks were in people registered with a general practice in the lowest deprivation quintile (compared to 13% of checks in Primary Care). There were 519 visits by the outreach service to 23 different types of venue. Certain venues recorded large numbers of checks e.g. supermarkets and libraries, but they were not always the most efficient places to recruit people for checks. Mosques and bus stations were the venues with the broadest reach to all target groups. Other venues, despite having lower turnover or recruitment rates, were still good settings to reach specific target groups. CONCLUSION The NHS Health Check can successfully be targeted at people from deprived areas and people of South Asian ethnicity using a targeted opportunistic community outreach approach. Our findings show that the reach to different groups varies substantially by venue, and therefore best results may be achieved by combining venues and strategies specific to the target group.
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Affiliation(s)
- D J Roberts
- Public Health Team, Buckinghamshire County Council, County Hall, Walton Street, Aylesbury, HP20 1UA, United Kingdom.
| | - V C de Souza
- Public Health Team, Buckinghamshire County Council, County Hall, Walton Street, Aylesbury, HP20 1UA, United Kingdom; Solutions for Public Health, 1 Wooton Edge Barns, Holly Bank, Wooton-by-Woodstock, Oxfordshire, OX20 1AE, United Kingdom.
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29
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Sallis A, Bunten A, Bonus A, James A, Chadborn T, Berry D. The effectiveness of an enhanced invitation letter on uptake of National Health Service Health Checks in primary care: a pragmatic quasi-randomised controlled trial. BMC FAMILY PRACTICE 2016; 17:35. [PMID: 27009045 PMCID: PMC4806508 DOI: 10.1186/s12875-016-0426-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The National Health Service Health Check (NHS HC) is a population level public health programme. It is a primary prevention initiative offering cardiovascular risk assessment and management for adults aged 40-74 years (every five years). It was designed to reduce the incidence of major vascular disease events by preventing or delaying the onset of diabetes, heart and kidney disease, stroke and vascular dementia . Effectiveness of the programme has been modelled on a national uptake of 75% however in 2012/13 uptake, nationally, was 49%. Ensuring a high percentage of those offered an NHS HC actually receive one is key to optimising the clinical and cost effectiveness of the programme. METHODS A pragmatic quasi-randomised controlled trial was conducted in four general practitioner practices in Medway, England with randomisation of 3511 patients. The aim was to compare attendance at the NHS HC using the standard national invitation template letter (control) compared to an enhanced invitation letter using insights from behavioural science (intervention). The intervention letter includes i) simplification - reducing letter content for less effortful processing ii) behavioural instruction - action focused language iii) personal salience - appointment due rather than invited and iv) addressing implementation intentions with a tear off slip to record the date, time and location of the appointment. Logistic Regression explored the association between control and intervention group and attendance at a health check. RESULTS 29.3% of patients who received the control letter and 33.5% of those who received the intervention letter attended their NHS HC (adjusted odds ratio 1.26, 95% confidence interval 1.09-1.47, p < 0.01). This was an absolute difference in uptake of 4.2 percentage points for those receiving the intervention letter. CONCLUSIONS An invitation letter applying behavioural insights was more effective than the existing national template letter at encouraging attendance at an NHS HC. Making small, no cost behaviourally informed changes to letter invitations can improve uptake of the NHS HC. Further research is required to replicate the effect with more robust methodology and powered for sub-group analysis including socio-economic status. TRIAL REGISTRATION Current Controlled Trials ISRCTN66757664 , date of registration 28/3/2014.
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Affiliation(s)
- Anna Sallis
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK.
| | - Amanda Bunten
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK
| | - Annabelle Bonus
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
| | - Andrew James
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
| | - Tim Chadborn
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK
| | - Daniel Berry
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
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30
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Lang SJ, Abel GA, Mant J, Mullis R. Impact of socioeconomic deprivation on screening for cardiovascular disease risk in a primary prevention population: a cross-sectional study. BMJ Open 2016; 6:e009984. [PMID: 27000783 PMCID: PMC4809080 DOI: 10.1136/bmjopen-2015-009984] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/22/2015] [Accepted: 11/16/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Investigate the association between socioeconomic deprivation and completeness of cardiovascular disease (CVD) risk factor recording in primary care, uptake of screening in people with incomplete risk factor recording and with actual CVD risk within the screened subgroup. DESIGN Cross-sectional study. SETTING Nine UK general practices. PARTICIPANTS 7987 people aged 50-74 years with no CVD diagnosis. METHODS CVD risk was estimated using the Framingham equation from data extracted from primary care electronic health records. Where there was insufficient information to calculate risk, patients were invited to attend a screening assessment. ANALYSIS Proportion of patients for whom clinical data were sufficiently complete to enable CVD risk to be calculated; proportion of patients invited to screening who attended; proportion of patients who attended screening whose 10-year risk of a cardiovascular event was high (>20%). For each outcome, a set of logistic regression models were run. Crude and adjusted ORs were estimated for person-level deprivation, age, gender and smoking status. We included practice-level deprivation as a continuous variable and practice as a random effect to account for clustering. RESULTS People who had lower Indices of Multiple Deprivation (IMD) scores (less deprived) had significantly worse routine CVD risk factor recording (adjusted OR 0.97 (0.95 to 1.00) per IMD decile; p=0.042). Screening attendance was poorer in those with more deprivation (adjusted OR 0.89 (0.86 to 0.91) per IMD decile; p<0.001). Among those who attended screening, the most deprived were more likely to have CVD risk >20% (OR 1.09 (1.03 to 1.15) per IMD decile; p=0.004). CONCLUSIONS Our data suggest that those who had the most to gain from screening were least likely to attend, potentially exacerbating existing health inequalities. Future research should focus on tailoring the delivery of CVD screening to ensure engagement of socioeconomically deprived groups.
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Affiliation(s)
- Sarah-Jane Lang
- General Practice & Primary Care Research Unit, University of Cambridge, Cambridge, UK
| | - Gary A Abel
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- General Practice & Primary Care Research Unit, University of Cambridge, Cambridge, UK
| | - Ricky Mullis
- General Practice & Primary Care Research Unit, University of Cambridge, Cambridge, UK
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Waterall J, Greaves F, Kearney M, Fenton KA. NHS Health Check: an innovative component of local adult health improvement and well-being programmes in England. J Public Health (Oxf) 2016; 37:177-84. [PMID: 26022808 DOI: 10.1093/pubmed/fdv062] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamie Waterall
- National Programme Lead NHS Health Check, Health and Wellbeing Directorate, Public Health England, London SE1 8UG, UK
| | - Felix Greaves
- National Programme Lead NHS Health Check, Health and Wellbeing Directorate, Public Health England, London SE1 8UG, UK
| | - Matt Kearney
- National Programme Lead NHS Health Check, Health and Wellbeing Directorate, Public Health England, London SE1 8UG, UK NHS England, London SE1 6LH, UK
| | - Kevin A Fenton
- National Programme Lead NHS Health Check, Health and Wellbeing Directorate, Public Health England, London SE1 8UG, UK
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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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Groenenberg I, Crone MR, van Dijk S, Ben Meftah J, Middelkoop BJC, Assendelft WJJ, Stiggelbout AM. Response and participation of underserved populations after a three-step invitation strategy for a cardiometabolic health check. BMC Public Health 2015; 15:854. [PMID: 26335782 PMCID: PMC4558779 DOI: 10.1186/s12889-015-2139-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022] Open
Abstract
Background Ethnic minority and native Dutch groups with a low socioeconomic status (SES) are underrepresented in cardiometabolic health checks, despite being at higher risk. We investigated response and participation rates using three consecutive inexpensive-to-costly culturally adapted invitation steps for a health risk assessment (HRA) and further testing of high-risk individuals during prevention consultations (PC). Methods A total of 1690 non-Western immigrants and native Dutch with a low SES (35–70 years) from six GP practices were eligible for participation. We used a ‘funnelled’ invitation design comprising three increasingly cost-intensive steps: (1) all patients received a postal invitation; (2) postal non-responders were approached by telephone; (3) final non-responders were approached face-to-face by their GP. The effect of ethnicity, ethnic mix of GP practice, and patient characteristics (gender, age, SES) on response and participation were assessed by means of logistic regression analyses. Results Overall response was 70 % (n = 1152), of whom 62 % (n = 712) participated in the HRA. This was primarily accomplished through the postal and telephone invitations. Participants from GP practices in the most deprived neighbourhoods had the lowest response and HRA participation rates. Of the HRA participants, 29 % (n = 207) were considered high-risk, of whom 59 % (n = 123) participated in the PC. PC participation was lowest among native Dutch with a low SES. Conclusions Underserved populations can be reached by a low-cost culturally adapted postal approach with a reminder and follow-up telephone calls. The added value of the more expensive face-to-face invitation was negligible. PC participation rates were acceptable. Efforts should be particularly targeted at practices in the most deprived areas. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2139-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iris Groenenberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Sandra van Dijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Jamila Ben Meftah
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Barend J C Middelkoop
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Willem J J Assendelft
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands. .,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, 2300, RC, Leiden, The Netherlands.
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Chang KCM, Soljak M, Lee JT, Woringer M, Johnston D, Khunti K, Majeed A, Millett C. Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study. Prev Med 2015; 78:1-8. [PMID: 26051202 DOI: 10.1016/j.ypmed.2015.05.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine coverage of NHS Health Check, a national cardiovascular risk assessment programme in England, in the first four years after implementation, and to examine prevalence of high cardiovascular disease (CVD) risk and uptake of statins in high risk patients. METHOD Study sample was 95,571 patients in England aged 40-74years continuously registered with 509 practices in the Clinical Practice Research Datalink between April 2009 and March 2013. Multilevel logistic regression models were used to assess predictors of Health Check attendance; elevated CVD risk factors and statin prescribing among attendees. RESULTS Programme coverage was 21.4% over four years, with large variations between practices (0%-72.7%) and regions (9.4%-30.7%). Coverage was higher in older patients (adjusted odds ratio 2.88, 95% confidence interval 2.49-3.31 for patients 70-74years) and in patients with a family history of premature coronary heart disease (2.37, 2.22-2.53), but lower in Black Africans (0.75, 0.61-0.92) and Chinese (0.68, 0.47-0.96) compared with White British. Coverage was similar in patients living in deprived and affluent areas. Prevalence of high CVD risk (QRISK2≥20%) among attendees was 4.6%. One third (33.6%) of attendees at high risk were prescribed a statin after Health Checks. CONCLUSIONS Coverage of the programme and statin prescribing in high risk individuals was low. Coverage was similar in deprived and affluent groups but lower in some ethnic minority groups, possibly widening inequalities. These findings raise a question about whether recommendations by WHO to develop CVD risk assessment programmes internationally will deliver anticipated health benefits.
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Affiliation(s)
- Kiara Chu-Mei Chang
- Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK.
| | - Michael Soljak
- Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK
| | - John Tayu Lee
- Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK
| | - Maria Woringer
- Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK
| | - Desmond Johnston
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, W6 8RP London, UK
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Abbas SZ, Pollard TM, Wynn P, Learmonth A, Joyce K, Bambra C. The effectiveness of using the workplace to identify and address modifiable health risk factors in deprived populations. Occup Environ Med 2015; 72:664-9. [PMID: 26150673 DOI: 10.1136/oemed-2014-102743] [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] [Received: 12/15/2014] [Accepted: 06/22/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To establish whether a programme of targeted health screening, with referral to appropriate interventions, offered to an employed but socioeconomically deprived group was effective in overcoming barriers to uptake of such services and improving a range of surrogate health markers for participants. METHODS Low-paid local government employees from socially and economically deprived areas in North-East England were invited to attend a free health check. Health checks were conducted within working hours and close to their worksite, and included assessment of a range of lifestyle and health-related risk factors, including those associated with cardiovascular disease (CVD). A range of additional interventions were offered where indicated. Participants were invited to repeat screening approximately 9 months later. RESULTS 635 (20% response rate) employees in the target age group (≥40 years) attended the first check. Most health risk markers improved in those (N=427) attending both health checks, as did the mean CVD risk score (t=2.86, p=0.004). 269 referrals were made to the intervention programmes. CONCLUSIONS This workplace programme had a positive impact on cardiovascular health, but attendance rates were low. These findings suggest that workplace health screening activities may have the potential to improve health in a group often considered hard to reach by other routes, but do not offer a straightforward solution in overcoming barriers to access for such subgroups within the working population.
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Affiliation(s)
- Syed Zakir Abbas
- Occupational Health Service, Sunderland City Council, Sunderland, UK
| | | | - Philip Wynn
- Occupational Health Service, Durham County Council, Durham, UK
| | - Alyson Learmonth
- Centre for Public Policy and Health, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Durham, UK
| | - Kerry Joyce
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Department of Geography, Durham University, Durham, UK
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Gidlow C, Ellis N, Randall J, Cowap L, Smith G, Iqbal Z, Kumar J. Method of invitation and geographical proximity as predictors of NHS Health Check uptake. J Public Health (Oxf) 2015; 37:195-201. [PMID: 25427882 PMCID: PMC4447133 DOI: 10.1093/pubmed/fdu092] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Uptake of NHS Health Checks remains below the national target. Better understanding of predictors of uptake can inform targeting and delivery. We explored invitation method and geographical proximity as predictors of uptake in deprived urban communities. METHODS This observational cohort study used data from all 4855 individuals invited for an NHS Health Check (September 2010-February 2014) at five general practices in Stoke-on-Trent, UK. Attendance/non-attendance was the binary outcome variable. Predictor variables included the method of invitation, general practice, demographics, deprivation and distance to Health Check location. RESULTS Mean attendance (61.6%) was above the city and national average, but varied by practice (47.5-83.3%; P < 0.001). Telephone/verbal invitations were associated with higher uptake than postal invitations (OR = 2.87, 95% CI = 2.26-3.64), yet significant practice-level variation remained. Distance to Health Check was not associated with attendance. Increasing age (OR = 1.04, 95% CI = 1.03-1.04), female gender (OR = 1.48, 95% CI = 1.30-1.68) and living in the least deprived areas (OR = 1.59, 95% CI = 1.23-2.05) were all independent positive predictors of attendance. CONCLUSIONS Using verbal or telephone invitations should be considered to improve Health Check uptake. Other differences in recruitment and delivery that might explain remaining practice-level variation in uptake warrant further exploration. Geographical proximity may not be an important predictor of uptake in urban populations.
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Affiliation(s)
- Christopher Gidlow
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Stoke on Trent ST4 2DF, UK
| | - Naomi Ellis
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Stoke on Trent ST4 2DF, UK
| | - Jason Randall
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Stoke on Trent ST4 2DF, UK
| | - Lisa Cowap
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Stoke on Trent ST4 2DF, UK
| | - Graham Smith
- Institute for Environment, Sustainability and Regeneration, Staffordshire University, Stoke on Trent ST4 2DF, UK
| | - Zafar Iqbal
- NHS Stoke on Trent, Public Health Directorate, Civic Centre, ST4 1HH, UK
| | - Jagdish Kumar
- Havering Public Health, Mercury House, Essex RM1 3DW, UK
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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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Ellis N, Gidlow C, Cowap L, Randall J, Iqbal Z, Kumar J. A qualitative investigation of non-response in NHS health checks. ACTA ACUST UNITED AC 2015; 73:14. [PMID: 25825674 PMCID: PMC4377903 DOI: 10.1186/s13690-015-0064-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/24/2015] [Indexed: 11/28/2022]
Abstract
Background Improving uptake of NHS Health Checks has become a priority in England, but there is a lack of data on the perceptions of programme non-attenders. This study aimed to explore how non-attenders of NHS Health Checks perceive the programme, identify reasons for non-attendance and inform strategies to improve uptake. Method This qualitative study involved individuals registered at four general practices in Stoke-on-Trent, UK, who had not taken up their invitation to a NHS Health Check. Semi-structured face-to-face and telephone interviews were audio-recorded and transcribed verbatim for Thematic Analysis. Results Interviews were completed with 19 males and 22 females (mean age 52.9 ± 8.5 years), who were socio-demographically representative of the non-attender population. Four main themes identified related to: the positive perception of the Health Check concept among non-attenders; the perceived lack of personal relevance; ineffective invitation method and appointment inconvenience were common barriers; previous experience of primary care can influence uptake. Conclusions Fundamental requirements for improving uptake are that individuals recognise the personal relevance of Health Checks and that attendance is convenient. Incorporating more sophisticated and personalised risk communication as part of the invitation could increase impact and promote candidacy. Flexibility and convenience of appointments should be considered by participating general practices.
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Affiliation(s)
- Naomi Ellis
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Christopher Gidlow
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Jason Randall
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Zafar Iqbal
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK ; Stoke-on-Trent City Council Public Health Directorate, Civic Centre, Glebe Street, Stoke-on-Trent, ST4 1HH UK
| | - Jagdish Kumar
- Havering Public Health, Mercury House, 12th Floor, Mercury Gardens, Romford, Essex RM1 3DW UK
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Forster AS, Dodhia H, Booth H, Dregan A, Fuller F, Miller J, Burgess C, McDermott L, Gulliford MC. Estimating the yield of NHS Health Checks in England: a population-based cohort study. J Public Health (Oxf) 2014; 37:234-40. [PMID: 25326192 DOI: 10.1093/pubmed/fdu079] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the yield of the NHS Health Checks programme. METHODS A cohort study, conducted in the Clinical Practice Research Datalink in England. Electronic health records were analysed for patients aged 40-74 receiving an NHS Health Check between 2010 and 2013. RESULTS There were 65 324 men and 75 032 women receiving a health check. For every 1000 men assessed, there were 205 smokers (95% confidence interval 195-215), 355 (340-369) with hypertension (≥140/90 mmHg) and 633 (607-658) with elevated cholesterol (≥5 mmol/l). Among 1000 women, there were 161 (151-171) smokers, 247 (238-257) with hypertension and 668 (646-689) with elevated cholesterol. In the 12 months following the check, statins were prescribed to 18% of men and 21% of women with ≥20% cardiovascular risk and antihypertensive drugs to 11% of men and 16% of women with ≥20% cardiovascular risk. Slight reductions in risk factor values were observed in the minority of participants with follow-up values recorded in the 15 months following the check. CONCLUSIONS A universal primary prevention programme identifies substantial risk factor burden in a population without known cardiovascular disease. Research is needed to monitor interventions, and intermediate- and long-term outcomes, in those identified at high risk.
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Affiliation(s)
| | - Hiten Dodhia
- Lambeth-Southwark Public Health Directorate, London SE1 2QH, UK
| | | | | | | | - Jane Miller
- London Borough of Lewisham, London SE6 4RU, UK
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McNaughton RJ, Shucksmith J. Reasons for (non)compliance with intervention following identification of 'high-risk' status in the NHS Health Check programme. J Public Health (Oxf) 2014; 37:218-25. [PMID: 25237034 PMCID: PMC4447131 DOI: 10.1093/pubmed/fdu066] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The Department of Health introduced a risk assessment, management and reduction programme, NHS Health Checks, which aimed to reduce premature morbidity and mortality from cardiovascular diseases for those aged 40–74. Those identified as at increased risk of CVD are offered prophylactic medication and lifestyle advice to reduce their risk. Health gains will only be achieved if patients are compliant with advice/intervention however. This study sought to understand factors that influenced adherence to medication and advice in ‘high-risk’ patients. Methods Qualitative data were collected through 29 semi-structured interviews with a purposive sample of individuals who had been identified as at high-risk of CVD. Participants had been offered lifestyle advice, lipid lowering medications and attended at least one annual review. Results Findings explore the challenges and experiences confronting ‘high-risk’ individuals when making decisions about engaging with intervention. Key findings explore: statin adherence, as well as adherence to advice about diet, physical activity, alcohol consumption and smoking cessation. Conclusions Attention needs to be paid to the way prophylactic medications are prescribed and explained to high-risk patients. Consistent provision of tailored lifestyle advice and access to appropriate services could facilitate sustained changes to factors that increase CVD risk.
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Affiliation(s)
- R J McNaughton
- School of Health and Care, Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK
| | - J Shucksmith
- School of Health and Care, Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK
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Opportunistic community-based health checks. Public Health 2014; 128:582-4. [PMID: 24916427 DOI: 10.1016/j.puhe.2014.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 11/24/2022]
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Hooper J, Chohan P, Caley M. Case detection of disease by NHS Health Checks in Warwickshire, England and comparison with predicted performance. Public Health 2014; 128:475-7. [PMID: 24856196 DOI: 10.1016/j.puhe.2014.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 11/17/2022]
Affiliation(s)
- J Hooper
- Public Health Warwickshire, Warwickshire County Council, Warwick, UK
| | - P Chohan
- Public Health Warwickshire, Warwickshire County Council, Warwick, UK
| | - M Caley
- Public Health Warwickshire, Warwickshire County Council, Warwick, UK.
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Badenbroek IF, Stol DM, Nielen MMJ, Hollander M, Kraaijenhagen RA, de Wit GA, Schellevis FG, de Wit NJ. Design of the INTEGRATE study: effectiveness and cost-effectiveness of a cardiometabolic risk assessment and treatment program integrated in primary care. BMC FAMILY PRACTICE 2014; 15:90. [PMID: 24884779 PMCID: PMC4022539 DOI: 10.1186/1471-2296-15-90] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/30/2014] [Indexed: 11/20/2022]
Abstract
Background The increasing prevalence of cardiometabolic disease (CMD) in combination with an ageing population is a major public health problem. Early detection and management of individuals at risk for CMD is required to prevent future health problems with associated costs. General practice is the optimal health care setting to accomplish this goal. Prevention programs for identification and treatment of patients with an increased risk for CMD in primary care have been proven feasible. However, the effectiveness and cost-effectiveness have yet to be demonstrated. The ‘Personalized Prevention Approach for CardioMetabolic Risk’ (PPA CMR) is such a prevention program. The objective of the INTEGRATE study is to investigate the effectiveness and cost-effectiveness of PPA CMR, as well as to establish determinants for participation and compliance. Methods The INTEGRATE study is designed as a stepped-wedge randomized controlled trial with a waiting list control group. In approximately 40 general practices, all enlisted patients without CMD aged 45–70 years, are invited to participate in PPA CMR. After an online risk estimation, patients with a score above risk threshold are invited to the GP for additional measurements, detailed risk profiling and tailored treatment of risk factors through medication and/or lifestyle counseling. At baseline and after twelve months of follow-up lifestyle, health and work status of all participants are established with online questionnaires. Additionally after twelve months, we will determine health care utilization, costs of PPA CMR and compliance. Primary endpoints are the number of newly detected patients with CMD and changes in individual risk factors between the intervention and waiting list control group. Medical data will be extracted from the GPs’ electronic medical records. In order to assess factors related to participation, we will send questionnaires to non-participants and assess characteristics of participating practices. For all participants, additional demographic characteristics will be available through Statistics Netherlands. Discussion The INTEGRATE study will provide insight into the effectiveness and cost-effectiveness of PPA CMR as well as determinants for participation and compliance, which represents essential information to guide further large-scale implementation of primary prevention programs for CMD. Trial registration number NTR4277, The Netherlands National Trial Register, 26-11-2013.
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Affiliation(s)
- Ilse F Badenbroek
- Netherlands Institute for Health Services Research (NIVEL), P,O, Box 1568, 3500 BN Utrecht, The Netherlands.
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Murray KA, Murphy DJ, Clements SJ, Brown A, Connolly SB. Comparison of uptake and predictors of adherence in primary and secondary prevention of cardiovascular disease in a community-based cardiovascular prevention programme (MyAction Westminster). J Public Health (Oxf) 2013; 36:644-50. [PMID: 24338795 DOI: 10.1093/pubmed/fdt118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the benefits of cardiac rehabilitation, uptake and adherence remain suboptimal. With the advent of NHS Health Checks, primary prevention programmes have also been advocated, but little is known about uptake and adherence rates. This study examined rates and predictors of adherence amongst patients with cardiovascular disease (CVD) and those at high multifactorial risk (HRI) attending an innovative programme integrating primary and secondary prevention. METHODS Comparison of rates of uptake and adherence and also predictors of adherence between 401 CVD patients and 483 HRI. The outcome was the number of sessions attended and predictor variables included clinical and psychosocial variables. Differences between groups were examined using t-tests and non-parametric tests. Multivariable regression analyses examined predictors of adherence. RESULTS Uptake to the assessment (CVD: 97%, HRI: 88%) and the programme (CVD: 78%, HRI: 74%) were high for both groups. An average of 8/12 was attended in both groups. Beliefs about treatment predicted adherence for both groups (P < 0.01). The alcohol causal belief also predicted poorer adherence amongst CVD patients (P < 0.02). Older age also predicted better adherence amongst HRI (P < 0.001). CONCLUSIONS Rates of uptake and adherence were high for both HRI and CVD patients. Further research is needed to examine whether interventions targeting predictor variables further improve adherence.
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Affiliation(s)
- Kathryn A Murray
- MyAction Westminster, Imperial College Healthcare NHS Trust, 5th Floor, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK Department of Neuropsychology and Clinical Health Psychology, 10th Floor, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - David J Murphy
- Department of Neuropsychology and Clinical Health Psychology, 10th Floor, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Sarah-Jane Clements
- MyAction Westminster, Imperial College Healthcare NHS Trust, 5th Floor, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | | | - Susan B Connolly
- MyAction Westminster, Imperial College Healthcare NHS Trust, 5th Floor, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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Baker J, Mitchell R, Lawson K, Pell J. Ethnic differences in the cost-effectiveness of targeted and mass screening for high cardiovascular risk in the UK: cross-sectional study. Heart 2013; 99:1766-71. [DOI: 10.1136/heartjnl-2013-304625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Artac M, Dalton ARH, Babu H, Bates S, Millett C, Majeed A. Primary care and population factors associated with NHS Health Check coverage: a national cross-sectional study. J Public Health (Oxf) 2013; 35:431-9. [PMID: 23881962 DOI: 10.1093/pubmed/fdt069] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION High and equitable coverage of systematic cardiovascular disease (CVD) prevention programmes, such as the NHS Health Check programme in England, is essential if they are to effectively reduce the population CVD burden. METHODS We conducted a cross-sectional study using data from 151 English primary care trusts (PCTs) on NHS Health Check coverage during 2011-12. We examined the associations between programme coverage and primary care and population factors, including patient demographics, primary care workforce and cardiovascular health need. RESULTS Median coverage of NHS Health Checks was 8.2%, with wide PCT-level variation (range = 0-29.8%). Coverage was significantly higher in PCTs in the most deprived areas compared with the least deprived (P = 0.035), adjusting for covariates. Significant negative associations between coverage and a higher proportion of PCT population aged 40-74 years-the eligible Health Check age group, a larger total population size and higher practice staffing levels were found in the unadjusted analyses. CONCLUSIONS NHS Health Check coverage during 2011-12 was lower than the government projection of 18% coverage. Coverage must be increased through concerted multi-disciplinary strategies, for the programme to improve cardiovascular health in England. Considerable variation in participation between PCTs warrants attention, with enhanced support for poor performers.
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Affiliation(s)
- M Artac
- Department of Primary Care and Public Health, Imperial College London, London, UK.
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