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Chung R, Xu Z, Arnold M, Ip S, Harrison H, Barrett J, Pennells L, Kim LG, Di Angelantonio E, Paige E, Ritchie SC, Inouye M, Usher‐Smith JA, Wood AM. Using Polygenic Risk Scores for Prioritizing Individuals at Greatest Need of a Cardiovascular Disease Risk Assessment. J Am Heart Assoc 2023; 12:e029296. [PMID: 37489768 PMCID: PMC7614905 DOI: 10.1161/jaha.122.029296] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
Background The aim of this study was to provide quantitative evidence of the use of polygenic risk scores for systematically identifying individuals for invitation for full formal cardiovascular disease (CVD) risk assessment. Methods and Results A total of 108 685 participants aged 40 to 69 years, with measured biomarkers, linked primary care records, and genetic data in UK Biobank were used for model derivation and population health modeling. Prioritization tools using age, polygenic risk scores for coronary artery disease and stroke, and conventional risk factors for CVD available within longitudinal primary care records were derived using sex-specific Cox models. We modeled the implications of initiating guideline-recommended statin therapy after prioritizing individuals for invitation to a formal CVD risk assessment. If primary care records were used to prioritize individuals for formal risk assessment using age- and sex-specific thresholds corresponding to 5% false-negative rates, then the numbers of men and women needed to be screened to prevent 1 CVD event are 149 and 280, respectively. In contrast, adding polygenic risk scores to both prioritization and formal assessments, and selecting thresholds to capture the same number of events, resulted in a number needed to screen of 116 for men and 180 for women. Conclusions Using both polygenic risk scores and primary care records to prioritize individuals at highest risk of a CVD event for a formal CVD risk assessment can efficiently prioritize those who need interventions the most than using primary care records alone. This could lead to better allocation of resources by reducing the number of risk assessments in primary care while still preventing the same number of CVD events.
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Affiliation(s)
- Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Zhe Xu
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Matthew Arnold
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Hannah Harrison
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Jessica Barrett
- Medical Research Council Biostatistics UnitUniversity of CambridgeUnited Kingdom
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Lois G. Kim
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Ellie Paige
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraAustralia
- The George Institute for Global HealthUNSW SydneyAustralia
| | - Scott C. Ritchie
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Michael Inouye
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- The George Institute for Global HealthUNSW SydneyAustralia
- Cambridge Baker Systems Genomics InitiativeBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Juliet A. Usher‐Smith
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- Cambridge Centre of Artificial Intelligence in MedicineUniversity of CambridgeUnited Kingdom
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Debiec R, Lawday D, Bountziouka V, Beeston E, Greengrass C, Bramley R, Sehmi S, Kharodia S, Newton M, Marshall A, Krzeminski A, Zafar A, Chahal A, Heer A, Khunti K, Joshi N, Lakhani M, Farooqi A, Patel R, Samani NJ. Evaluating the clinical effectiveness of the NHS Health Check programme: a prospective analysis in the Genetics and Vascular Health Check (GENVASC) study. BMJ Open 2023; 13:e068025. [PMID: 37253489 PMCID: PMC10230936 DOI: 10.1136/bmjopen-2022-068025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/18/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The aim of the study was to assess the clinical effectiveness of the national cardiovascular disease (CVD) prevention programme-National Health Service Health Check (NHSHC) in reduction of CVD risk. DESIGN Prospective cohort study. SETTING 147 primary care practices in Leicestershire and Northamptonshire in England, UK. PARTICIPANTS 27 888 individuals undergoing NHSHC with a minimum of 18 months of follow-up data. OUTCOME MEASURES The primary outcomes were NHSHC attributed detection of CVD risk factors, prescription of medications, changes in values of individual risk factors and frequency of follow-up. RESULTS At recruitment, 18% of participants had high CVD risk (10%-20% 10-year risk) and 4% very high CVD risk (>20% 10-year risk). New diagnoses or hypertension (HTN) was made in 2.3% participants, hypercholesterolaemia in 0.25% and diabetes mellitus in 0.9%. New prescription of stains and antihypertensive medications was observed in 5.4% and 5.4% of participants, respectively. Total cholesterol was decreased on average by 0.38 mmol/L (95% CI -0.34 to -0.41) and 1.71 mmol/L (-1.48 to -1.94) in patients with initial cholesterol >5 mmol/L and >7.5 mmol/L, respectively. Systolic blood pressure was decreased on average by 2.9 mm Hg (-2.3 to -3.7), 15.7 mm Hg (-14.1 to -17.5) and 33.4 mm Hg (-29.4 to -37.7), in patients with grade 1, 2 and 3 HTN, respectively. About one out of three patients with increased CVD risk had no record of follow-up or treatment. CONCLUSIONS Majority of patients identified with increased CVD risk through the NHSHC were followed up and received effective clinical interventions. However, one-third of high CVD risk patients had no follow-up and therefore did not receive any treatment. Our study highlights areas of focus which could improve the effectiveness of the programme. TRIAL REGISTRATION NUMBER NCT04417387.
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Affiliation(s)
- Radoslaw Debiec
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Daniel Lawday
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Vasiliki Bountziouka
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
- Department of Food Science and Nutrition, University of the Aegean, Lemnos, Greece
| | - Emma Beeston
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Chris Greengrass
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Richard Bramley
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Sue Sehmi
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Shireen Kharodia
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Michelle Newton
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Andrea Marshall
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | | | - Azhar Zafar
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes and Cardiovascular Medicine General Practice Alliance Federation Research and Training Academy, Northampton, UK
| | - Anuj Chahal
- South Leicestershire Medical Group, Kibworth Beauchamp, UK
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Mayur Lakhani
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Azhar Farooqi
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Riyaz Patel
- Institute of Cardiovascular Science, University College London, London, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK
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Haș IM, Teleky BE, Vodnar DC, Ștefănescu BE, Tit DM, Nițescu M. Polyphenols and Cardiometabolic Health: Knowledge and Concern among Romanian People. Nutrients 2023; 15:2281. [PMID: 37242164 PMCID: PMC10221773 DOI: 10.3390/nu15102281] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The cardiometabolic health of the population is a crucial indicator of public health, considering the significant impact of cardiovascular disease (CVD) and diabetes on global mortality. Determining the population's knowledge and the predictors of these pathologies is essential in developing effective educational and clinical strategies for the prevention and management of cardiometabolic risk (CMR). Polyphenols are natural compounds with a multitude of beneficial effects on cardiometabolic health. This study explored the current knowledge, understanding, and awareness of CMR, the benefits of polyphenols among Romanians, and how sociodemographic and clinical characteristics influence this aspect. Five hundred forty-six subjects responded anonymously to an online questionnaire designed to assess their knowledge. The data were collected and analyzed based on gender, age, education level, and BMI status. Most respondents expressed concern to a great or very great extent about their health (78%) and food (60%), with significant differences (p < 0.05) depending on age, educational level, and BMI status. Of the respondents, 64.8% declared that they were familiar with the CMR term. Still, the results showed a weak correlation between the stated risk factors and the self-assessment of increased risk (r = 0.027) for CVD or diabetes. Only 35% of the respondents reported a good or very good knowledge of the term "polyphenols", 86% recognized the antioxidant effect, and significantly fewer (26%) recognized the prebiotic effect. Developing and implementing targeted educational strategies to enhance learning and individual behaviors related to CMR factors and the benefits of polyphenols is necessary.
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Affiliation(s)
- Ioana Mariana Haș
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania;
| | - Bernadette-Emőke Teleky
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (B.-E.T.); (D.-C.V.)
- Department of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Dan-Cristian Vodnar
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (B.-E.T.); (D.-C.V.)
- Department of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Bianca Eugenia Ștefănescu
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (B.-E.T.); (D.-C.V.)
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania
| | - Maria Nițescu
- Department of Preclinical–Complementary Sciences, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
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Tildy BE, McNeill A, Perman-Howe PR, Brose LS. Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies. BMC PRIMARY CARE 2023; 24:32. [PMID: 36698052 PMCID: PMC9875430 DOI: 10.1186/s12875-023-01981-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Internationally, there is an 'evidence-practice gap' in the rate healthcare professionals assess tobacco use and offer cessation support in clinical practice, including primary care. Evidence is needed for implementation strategies enacted in the 'real-world'. AIM To identify implementation strategies aiming to increase smoking cessation treatment provision in primary care, their effectiveness, cost-effectiveness and any perceived facilitators and barriers for effectiveness. METHODS 'Embase', 'Medline', 'PsycINFO', 'CINAHL', 'Global Health', 'Social Policy & Practice', 'ASSIA Applied Social Sciences Index and Abstracts' databases, and grey literature sources were searched from inception to April 2021. Studies were included if they evaluated an implementation strategy implemented on a nation-/state-wide scale, targeting any type of healthcare professional within the primary care setting, aiming to increase smoking cessation treatment provision. PRIMARY OUTCOME MEASURES implementation strategy identification, and effectiveness (practitioner-/patient-level). SECONDARY OUTCOME MEASURES perceived facilitators and barriers to effectiveness, and cost-effectiveness. Studies were assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A narrative synthesis was conducted using the Expert Recommendations for Implementing Change (ERIC) compilation and the Consolidated Framework for Implementation Research (CFIR). RESULTS Of 49 included papers, half were of moderate/low risk of bias. The implementation strategy domains identified involved utilizing financial strategies, changing infrastructure, training and educating stakeholders, and engaging consumers. The first three increased practitioner-level smoking status recording and cessation advice provision. Interventions in the utilizing financial strategies domain also appeared to increase smoking cessation (patient-level). Key facilitator: external policies/incentives (tobacco control measures and funding for public health and cessation clinics). Key barriers: time and financial constraints, lack of free cessation medications and follow-up, deprioritisation and unclear targets in primary care, lack of knowledge of healthcare professionals, and unclear messaging to patients about available cessation support options. No studies assessed cost-effectiveness. CONCLUSIONS Some implementation strategy categories increased the rate of smoking status recording and cessation advice provision in primary care. We found some evidence for interventions utilizing financial strategies having a beneficial impact on cessation. Identified barriers to effectiveness should be reduced. More pragmatic approaches are recommended, such as hybrid effectiveness-implementation designs and utilising Multiphase Optimization Strategy methodology. PROTOCOL REGISTRATION PROSPERO:CRD42021246683.
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Affiliation(s)
- Bernadett E Tildy
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK. .,SPECTRUM Consortium, London, UK.
| | - Ann McNeill
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
| | - Parvati R Perman-Howe
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
| | - Leonie S Brose
- Addictions Department, King's College London, Addiction Sciences Building, Denmark Hill Campus, 4 Windsor Walk, London, SE5 8BB, UK.,SPECTRUM Consortium, London, UK
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Jeong YW, Jung Y, Jeong H, Huh JH, Sung KC, Shin JH, Kim HC, Kim JY, Kang DR. Prediction Model for Hypertension and Diabetes Mellitus Using Korean Public Health Examination Data (2002–2017). Diagnostics (Basel) 2022; 12:diagnostics12081967. [PMID: 36010317 PMCID: PMC9407141 DOI: 10.3390/diagnostics12081967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/13/2022] [Indexed: 11/21/2022] Open
Abstract
Hypertension and diabetes mellitus are major chronic diseases that are important factors in the management of cardiovascular disease. In order to prevent the occurrence of chronic diseases, proper health management through periodic health check-ups is necessary. The purpose of this study is to determine the incidence of hypertension and diabetes mellitus according to the health check-up, and to develop a predictive model for hypertension and diabetes according to the health check-up. We used the National Health Insurance Corporation database of Korea and checked whether hypertension or diabetes occurred from that date according to the number of health check-ups over the past 10 years. Compared to those who underwent five health check-ups, those who participated in the first screening had hypertension (OR = 2.18, 95% CI = 2.14–2.22), diabetes mellitus (OR = 1.33, 95% CI = 1.30–1.35) and both diseases (OR = 2.46, 95% CI = 2.39–2.53); individuals who underwent 10 screenings had hypertension (OR = 0.86, 95% CI = 0.83–0.88), diabetes mellitus (OR = 0.83, 95% CI = 0.81–0.85) and both diseases (OR = 0.83, 95% CI = 0.79–0.87). Individuals who attended fewer than five screenings compared with individuals who attended five or more screenings had hypertension (OR = 1.61, 95% CI = 1.59–1.62; AUC = 0.66), diabetes mellitus (OR = 1.21, 95% CI = 1.20–1.22; AUC = 0.59) and both diseases (OR = 1.75, 95% CI = 1.72–1.78, AUC = 0.63). The machine learning-based prediction model using XGBoost showed higher performance in all datasets than the conventional logistic regression model in predicting hypertension (accuracy, 0.828 vs. 0.628; F1-score, 0.800 vs. 0.633; AUC, 828 vs. 0.630), diabetes mellitus (accuracy, 0.707 vs. 0.575; F1-score, 0.663 vs. 0.576; AUC, 0.710 vs. 0.575) and both diseases (accuracy, 0.950 vs. 0.612; F1-score, 0.950 vs. 0.614; AUC, 0.952 vs. 0.612). It was found that health check-up had a great influence on the occurrence of hypertension and diabetes, and screening frequency was more important than other factors in the variable importances.
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Affiliation(s)
- Yong Whi Jeong
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Yeojin Jung
- Department of Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Hoyeon Jeong
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Ji Hye Huh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Jang Young Kim
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Dae Ryong Kang
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
- Correspondence: ; Tel.: +82-33-0391
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Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Cardiovascular disease risk communication in NHS Health Checks using QRISK®2 and JBS3 risk calculators: the RICO qualitative and quantitative study. Health Technol Assess 2021; 25:1-124. [PMID: 34427556 DOI: 10.3310/hta25500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The NHS Health Check is a national cardiovascular disease prevention programme. There is a lack of evidence on how health checks are conducted, how cardiovascular disease risk is communicated to foster risk-reducing intentions or behaviour, and the impact on communication of using different cardiovascular disease risk calculators. OBJECTIVES RIsk COmmunication in Health Check (RICO) study aimed to explore practitioner and patient understanding of cardiovascular disease risk, the associated advice or treatment offered by the practitioner, and the response of the patients in health checks supported by either the QRISK®2 or the JBS3 lifetime risk calculator. DESIGN This was a qualitative study with quantitative process evaluation. SETTING Twelve general practices in the West Midlands of England, stratified on deprivation of the local area (bottom 50% vs. top 50%), and with matched pairs randomly allocated to use QRISK2 or JBS3 during health checks. PARTICIPANTS A total of 173 patients eligible for NHS Health Check and 15 practitioners. INTERVENTIONS The health check was delivered using either the QRISK2 10-year risk calculator (usual practice) or the JBS3 lifetime risk calculator, with heart age, event-free survival age and risk score manipulation (intervention). RESULTS Video-recorded health checks were analysed quantitatively (n = 173; JBS3, n = 100; QRISK2, n = 73) and qualitatively (n = 128; n = 64 per group), and video-stimulated recall interviews were undertaken with 40 patients and 15 practitioners, with 10 in-depth case studies. The duration of the health check varied (6.8-38 minutes), but most health checks were short (60% lasting < 20 minutes), with little cardiovascular disease risk discussion (average < 2 minutes). The use of JBS3 was associated with more cardiovascular disease risk discussion and fewer practitioner-dominated consultations than the use of QRISK2. Heart age and visual representations of risk, as used in JBS3, appeared to be better understood by patients than 10-year risk (QRISK2) and, as a result, the use of JBS3 was more likely to lead to discussion of risk factors and their management. Event-free survival age was not well understood by practitioners or patients. However, a lack of effective cardiovascular disease risk discussion in both groups increased the likelihood of a maladaptive coping response (i.e. no risk-reducing behaviour change). In both groups, practitioners often missed opportunities to check patient understanding and to tailor information on cardiovascular disease risk and its management during health checks, confirming apparent practitioner verbal dominance. LIMITATIONS The main limitations were under-recruitment in some general practices and the resulting imbalance between groups. CONCLUSIONS Communication of cardiovascular disease risk during health checks was brief, particularly when using QRISK2. Patient understanding of and responses to cardiovascular disease risk information were limited. Practitioners need to better engage patients in discussion of and action-planning for their cardiovascular disease risk to reduce misunderstandings. The use of heart age, visual representation of risk and risk score manipulation was generally seen to be a useful way of doing this. Future work could focus on more fundamental issues of practitioner training and time allocation within health check consultations. TRIAL REGISTRATION Current Controlled Trials ISRCTN10443908. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Keele, Newcastle-under-Lyme, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - David Clark-Carter
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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Abstract
IMPORTANCE General health checks, also known as general medical examinations, periodic health evaluations, checkups, routine visits, or wellness visits, are commonly performed in adult primary care to identify and prevent disease. Although general health checks are often expected and advocated by patients, clinicians, insurers, and health systems, others question their value. OBSERVATIONS Randomized trials and observational studies with control groups reported in prior systematic reviews and an updated literature review through March 2021 were included. Among 19 randomized trials (906 to 59 616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check, 7 evaluated annual health checks, 1 evaluated biannual checks, and 6 evaluated health checks delivered at other frequencies. Twelve of 13 observational studies (240 to 471 415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n = 7229), adults aged 40 to 64 years who were invited to 2 health checks over 2 years, compared with adults not invited to screening, experienced no 8-year mortality benefit (6% vs 5%). General health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors, such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. In the Danish Check-In Study (n = 1104), more patients randomized to receive to a single health check, compared with those randomized to receive usual care, received a new antidepressant prescription over 1 year (5% vs 2%; P = .007). In a propensity score-matched analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual Wellness Visit, compared with those who did not, underwent colorectal cancer screening (69% vs 60%; P < .01). General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. In the OXCHECK trial (n = 4121), fewer patients randomized to receive annual health checks, compared with those not randomized to receive health checks, exercised less than once per month (68% vs 71%; difference, 3.3% [95% CI, 0.5%-6.1%]). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advance directives. CONCLUSIONS AND RELEVANCE General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment, risk factor control, preventive service uptake, and improved patient-reported outcomes. Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection or inadequate access to primary care.
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Affiliation(s)
- David T Liss
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Toshiko Uchida
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cheryl L Wilkes
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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de Waard AM, Korevaar JC, Hollander M, Nielen MMJ, Seifert B, Carlsson AC, Lionis C, Søndergaard J, Schellevis FG, de Wit NJ. Unwillingness to participate in health checks for cardiometabolic diseases: A survey among primary health care patients in five European countries. Health Sci Rep 2021; 4:e256. [PMID: 33778166 PMCID: PMC7988616 DOI: 10.1002/hsr2.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS Since cardiometabolic diseases (CMD) are a frequent cause of death worldwide, preventive strategies are needed. Recruiting adults for a health check could facilitate the identification of individuals at risk for CMD. For successful results, participation is crucial. We aimed to identify factors related to unwillingness to participate in CMD health checks. METHODS We performed a cross-sectional study in the Czech Republic, Denmark, Greece, the Netherlands, and Sweden. A questionnaire was distributed among persons without known CMD consulting general practice between January and July 2017 within the framework of the SPIMEU study. RESULTS In total, 1354 persons responded. Nine percent was unwilling to participate in a CMD health check. Male gender, smoking, higher self-rated health, never been invited before, and not willing to pay were related to unwillingness to participate. The most mentioned reason for unwillingness to participate was "I think that I am healthy" (57%). Among the respondents who were willing to participate, 94% preferred an invitation by the general practitioner and 66% was willing to pay. CONCLUSION A minority of the respondents was unwilling to participate in a CMD health check with consistent results within the five countries. This provides a promising starting point to increase participation in CMD health checks in primary care.
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Affiliation(s)
- Anne‐Karien M. de Waard
- Department of General Practice, Julius CenterUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Joke C. Korevaar
- Nivel (Netherlands Institute for Health Services Research), Department of general practice careUtrechtThe Netherlands
| | - Monika Hollander
- Department of General Practice, Julius CenterUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Mark M. J. Nielen
- Nivel (Netherlands Institute for Health Services Research), Department of general practice careUtrechtThe Netherlands
| | - Bohumil Seifert
- First Faculty of MedicineInstitute of General Practice, Charles UniversityPragueCzech Republic
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS)Karolinska InstitutetStockholmSweden
- Academic Primary Healthcare Centre, Department of Primary Health Care, Stockholm RegionStockholmSweden
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of MedicineUniversity of CreteHeraklionGreece
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - François G. Schellevis
- Nivel (Netherlands Institute for Health Services Research), Department of general practice careUtrechtThe Netherlands
- Department of General Practice & Elderly Care MedicineAmsterdam Public Health Research Institute, VU University Medical CenterAmsterdamThe Netherlands
| | - Niek J. de Wit
- Department of General Practice, Julius CenterUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
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9
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NHS Health Checks: an observational study of equity and outcomes 2009-2017. Br J Gen Pract 2021; 71:e701-e710. [PMID: 33587723 PMCID: PMC8216267 DOI: 10.3399/bjgp.2020.1021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/29/2021] [Indexed: 12/25/2022] Open
Abstract
Background The NHS Health Check cardiovascular prevention programme is now 10 years old. Aim To describe NHS Heath Check attendance, new diagnoses, and treatment in relation to equity indicators. Design and setting A nationally representative database derived from 1500 general practices from 2009–2017. Method The authors compared NHS Health Check attendance and new diagnoses and treatments by age, sex, ethnic group, and deprivation. Results In 2013–2017, 590 218 (16.9%) eligible people aged 40–74 years attended an NHS Health Check and 2 902 598 (83.1%) did not attend. South Asian ethnic groups were most likely to attend compared to others, and females more than males. New diagnoses were more likely in attendees than non-attendees: hypertension 25/1000 in attendees versus 9/1000 in non-attendees; type 2 diabetes 8/1000 versus 3/1000; and chronic kidney disease (CKD) 7/1000 versus 4/1000. In people aged ≥65 years, atrial fibrillation was newly diagnosed in 5/1000 attendees and 3/1000 non-attendees, and for dementia 2/1000 versus 1/1000, respectively. Type 2 diabetes, hypertension, and CKD were more likely in more deprived groups, and in South Asian, Black African, and Black Caribbean ethnic groups. Attendees were more likely to be prescribed statins (26/1000) than non-attendees (8/1000), and antihypertensive medicines (25/1000 versus 13/1000 non-attendees). However, of the 117 963 people with ≥10% CVD risk who were eligible for statins, only 9785 (8.3%) were prescribed them. Conclusion Uptake of NHS Health Checks remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension, and CKD, and to receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, <10% were treated. Policy reviews should consider a targeted approach prioritising those at highest CVD risk for face-to-face contact and consider other options for those at lower CVD risk.
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10
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Gidlow CJ, Ellis NJ, Cowap L, Riley VA, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators. BMJ Open 2020; 10:e037790. [PMID: 32978197 PMCID: PMC7520846 DOI: 10.1136/bmjopen-2020-037790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators. DESIGN RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation. SETTING AND PARTICIPANTS Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity. METHODS Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management. RESULTS 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17). CONCLUSIONS There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences. TRIAL REGISTRATION NUMBER ISRCTN10443908.
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Affiliation(s)
| | - Naomi J Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Department of Psychology, Staffordshire University, Stoke on Trent, UK
| | - Victoria A Riley
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke on Trent, UK
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11
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Cheong AT, Tong SF, Chinna K, Khoo EM, Liew SM. Gender differences in factors influencing intention to undergo cardiovascular disease health checks: A cross-sectional survey. PLoS One 2020; 15:e0239679. [PMID: 32970741 PMCID: PMC7514016 DOI: 10.1371/journal.pone.0239679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022] Open
Abstract
Background Undergo a health check for cardiovascular disease (CVD) is an important strategy to improve cardiovascular (CV) health. Men are reported to be less likely to undergo cardiovascular disease (CVD) health check than women. Gender difference could be one of the factors influencing health seeking behaviour of men and women. We aimed to identify gender differences in factors influencing the intention to undergo CVD health checks. Methods This was a cross-sectional survey using mall intercept interviews. Malaysians aged ≥30 years without known CVD were recruited. They were asked for their intention to undergo CVD health checks and associated factors. The factors included seven internal factors that were related to individuals’ attitude, perception and preparedness for CVD health checks and two external factors that were related to external resources. Hierarchical ordinal regression analysis was used to evaluate the importance of the factors on intention to undergo CVD health checks, for men and women separately. Results 397 participants were recruited, 60% were women. For men, internal factors explained 31.6% of the variances in likeliness and 9.6% of the timeline to undergo CVD health checks, with 1.2% and 1.8% added respectively when external factors were sequentially included. For women, internal factors explained 18.9% and 22.1% of the variances, with 3.1% and 4.2% added with inclusion of the external factors. In men, perceived drawbacks of health checks was a significant negative factor associated with likeliness to undergo CVD health checks (coefficient = -1.093; 95%CI:-1.592 to -0.594), and timeline for checks (coefficient = -0.533; 95%CI:-0.975 to -0.091). In women, readiness to handle outcomes following health checks was significantly associated with likeliness to undergo the checks (coefficient = 0.575; 95%CI: 0.063 to 1.087), and timeline for checks (coefficient = 0.645; 95%CI: 0.162 to 1.128). Both external factors 1) influence by significant others (coefficient = 0.406; 95%CI: 0.013 to 0.800) and 2) external barriers (coefficient = -0.440; 95%CI:-0.869 to -0.011) were also significantly associated with likeliness to undergo CVD health checks in women. Conclusions Both men and women were influenced by internal factors in their intention to undergo CVD health checks, and women were also influenced by external factors. Interventions to encourage CVD health checks need to focus on internal factors and be gender sensitive.
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Affiliation(s)
- Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail: ,
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University Malaysia, Subang Jaya, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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12
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Packham C, Butcher E, Williams M, Miksza J, Morriss R, Khunti K. Cardiovascular risk profiles and the uptake of the NHS Healthcheck programme in male prisoners in six UK prisons: an observational cross-sectional survey. BMJ Open 2020; 10:e033498. [PMID: 32448789 PMCID: PMC7253003 DOI: 10.1136/bmjopen-2019-033498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Half of all deaths in custody are due to natural causes, the most common being cardiovascular disease (CVD). National Health Service Healthchecks should be available to all eligible prisoners; it is not clear who receives them. Mental health issues are common in prisoners and may affect how healthcare interventions should be delivered. Current policy is to offer Healthchecks to those serving over 2 years in prison. OBJECTIVES, METHODS, SETTING AND DESIGN An observational cross-sectional survey in six male prisons in England between September 2017 and January 2019 in prisoners aged 35-74 to identify who was eligible for a Healthcheck and compare CVD risk data with those that were not, and factors associated with uptake. OUTCOME MEASURES Characteristics of those accepting a Healthcheck were compared with those declining. Assessments of anxiety and depression were compared with CVD risk factors. RESULTS 1207 prisoners completed a Healthcheck. 21.8% of prisoners were ineligible due to existing comorbidities. 76.4% of those invited took up a Healthcheck, and of those, 12.1% were found to have new significant CVD comorbidity. CVD risk was similar to community levels but this population was 10 years younger. Definite case-level depression or anxiety was present in 20.7% and 18.0%, respectively, of participants. An association was found between ethnicity and those invited (p=0.023, φ=0.1) and accepting (p=0.008, φ=0.1) a Healthcheck. 9.7% of prisoners serving less than 2 years had CVD risk scores of 10% or more, and had similar CVD risk profiles but much higher levels of anxiety (p<0.001, φ=0.2) or depression (p=0.009, φ=0.2) than those serving 2 years or more. CONCLUSION Cardiovascular risk was comparable with community rates and in some prisons, much higher. Rates of anxiety and depression were high. The national policy for selecting prisoners for Healthchecks may leave many high-risk prisoners without appropriate cardiovascular preventative assessments.
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Affiliation(s)
| | - Elizabeth Butcher
- Institute of Mental Health, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Marie Williams
- Institute of Mental Health, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Joanne Miksza
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Richard Morriss
- University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Smith CE, Hill SE, Amos A. Impact of specialist and primary care stop smoking support on socio-economic inequalities in cessation in the United Kingdom: a systematic review and national equity initial review completed 22 January 2019; final version accepted 19 July 2019 analysis. Addiction 2020; 115:34-46. [PMID: 31357250 PMCID: PMC6973008 DOI: 10.1111/add.14760] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/22/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Abstract
AIM To assess the impact of UK specialist and primary care-based stop smoking support on socio-economic inequalities in cessation. METHODS Systematic review and narrative synthesis, with a national equity analysis of stop smoking services (SSS). Ten bibliographic databases were searched for studies of any design, published since 2012, which evaluated specialist or primary care-based stop smoking support by socio-economic status (SES) or within a disadvantaged group. Studies could report on any cessation-related outcome. National Statistics were combined to estimate population-level SSS reach and impact among all smokers by SES. Overall, we included 27 published studies and three collated, national SSS reports for England, Scotland and Northern Ireland (equivalent data for Wales were unavailable). RESULTS Primary care providers and SSS in the United Kingdom were particularly effective at engaging and supporting disadvantaged smokers. Low SES groups were more likely to have their smoking status assessed, to receive general practitioner brief cessation advice/SSS referral and to attempt a quit with SSS support. Although disadvantaged SSS clients were less successful in quitting, increased service reach offset these lower quit rates, resulting in higher service impact among smokers from low SES groups. Interventions that offer tailored and targeted support have the potential to improve quit outcomes among disadvantaged smokers. CONCLUSIONS Equity-orientated stop smoking support can compensate for lower quit rates among disadvantaged smokers through the use of equity-based performance targets, provision of targeted services and the development of tailored interventions.
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Affiliation(s)
- Caroline E. Smith
- GRIT, Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - Sarah E. Hill
- GRIT, Global Public Health UnitUniversity of EdinburghEdinburghUK
| | - Amanda Amos
- GRIT, Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
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14
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Tai YH, Chen TL, Cherng YG, Yeh CC, Chang CC, Liao CC. Previous Use of Mammography as a Proxy for General Health Checks in Association with Better Outcomes after Major Surgeries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224432. [PMID: 31726700 PMCID: PMC6888288 DOI: 10.3390/ijerph16224432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/27/2022]
Abstract
Although previous studies have shown that health checks may improve several risk factors for chronic diseases, the effect of preoperative health checks on postoperative recovery in surgical patients remains unknown. We aimed to investigate the association between preoperative use of mammography and the risk of perioperative complications. We conducted a matched cohort study of 152,411 patients aged ≥47 years who received mammography screening and later underwent major surgery from 2008 to 2013. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 152,411 controls who underwent surgery but were not screened were selected. We collected patients’ characteristics and medical conditions from claims data of Taiwan’s National Health Insurance. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative complications and in-hospital mortality associated with mammography screening. Patients receiving mammography prior to major surgery had significantly lower risks of perioperative complications, including pneumonia, septicemia, acute renal failure, stroke, urinary tract infection, deep wound infection, acute myocardial infarction, intensive care unit stay, and 30 day in-hospital mortality (OR 0.45, 95% CI 0.38–0.53). The association was consistent across each stratum of age, number of hospitalizations, emergency visits, and comorbidities. In conclusion, preoperative use of mammography was strongly associated with fewer perioperative complications and less in-hospital mortality after major surgeries. The evidence provided by this study justifies the implementation of preoperative health checks in clinical practice.
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Affiliation(s)
- Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 110, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 110, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Department of Surgery, University of Illinois, Chicago, IL 60607, USA
| | - Chuen-Chau Chang
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
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15
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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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16
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de Waard AKM, Hollander M, Korevaar JC, Nielen MMJ, Carlsson AC, Lionis C, Seifert B, Thilsing T, de Wit NJ, Schellevis FG. Selective prevention of cardiometabolic diseases: activities and attitudes of general practitioners across Europe. Eur J Public Health 2019; 29:88-93. [PMID: 30016426 PMCID: PMC6345147 DOI: 10.1093/eurpub/cky112] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Cardiometabolic diseases (CMDs) are the number one cause of death. Selective prevention of CMDs by general practitioners (GPs) could help reduce the burden of CMDs. This measure would entail the identification of individuals at high risk of CMDs—but currently asymptomatic—followed by interventions to reduce their risk. No data were available on the attitude and the extent to which European GPs have incorporated selective CMD prevention into daily practice. Methods A survey among 575 GPs from the Czech Republic, Denmark, Greece, the Netherlands and Sweden was conducted between September 2016 and January 2017, within the framework of the SPIMEU-project. Results On average, 71% of GPs invited their patients to attend for CMD risk assessment. Some used an active approach (47%) while others used an opportunistic approach (53%), but these values differed between countries. Most GPs considered selective CMD prevention as useful (82%) and saw it as part of their normal duties (84%). GPs who did find selective prevention useful were more likely to actively invite individuals compared with their counterparts who did not find prevention useful. Most GPs had a disease management programme for individuals with risk factor(s) for cardiovascular disease (71%) or diabetes (86%). Conclusions Although most GPs considered selective CMD prevention as useful, it was not universally implemented. The biggest challenge was the process of inviting individuals for risk assessment. It is important to tailor the implementation of selective CMD prevention in primary care to the national context, involving stakeholders at different levels.
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Affiliation(s)
- Anne-Karien M de Waard
- Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monika Hollander
- Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joke C Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mark M J Nielen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece
| | - Bohumil Seifert
- Institute of General Practice, First Faculty of Medicine, Charles University, Prague, The Czech Republic
| | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Niek J de Wit
- Department of General Practice, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - François G Schellevis
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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17
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Health checks and cardiovascular risk factor values over six years' follow-up: Matched cohort study using electronic health records in England. PLoS Med 2019; 16:e1002863. [PMID: 31361740 PMCID: PMC6667114 DOI: 10.1371/journal.pmed.1002863] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The National Health Service (NHS) in England introduced a population-wide programme for cardiovascular disease (CVD) prevention in 2009, known as NHS Health Checks. This research aimed to measure the cardiovascular risk management and cardiovascular risk factor outcomes of the health check programme during six years' follow-up. METHODS AND FINDINGS A controlled interrupted time series study was conducted. Participants were registered with general practices in the Clinical Practice Research Datalink (CPRD) in England and received health checks between 1 April 2010 and 31 December 2013. Control participants, who did not receive a health check, were matched for age, sex, and general practice. Outcomes were blood pressure, body mass index (BMI), smoking, and total cholesterol (TC) and high-density lipoprotein cholesterol (HDL). Analyses estimated the net effect of health check by year, allowing for the underlying trend in risk factor values and baseline differences between cases and controls, adjusting for age, sex, deprivation, and clustering by general practice. There were 127,891 health check participants and 322,910 matched controls. Compared with controls, health check participants had lower BMI (cases mean 27.0, SD 4.8; controls 27.3, SD 5.6, Kg/m2), systolic blood pressure (SBP) (cases 129.0, SD 14.3; controls 129.3, SD 15.0, mm Hg), and smoking (21% in health check participants versus 27% in controls), but total and HDL cholesterol were similar. Health check participants were more likely to receive weight management advice (adjusted hazard ratio [HR] 5.03, 4.98 to 5.08, P < 0.001), smoking cessation interventions (HR 3.20, 3.13 to 3.27, P < 0.001), or statins (HR 1.24, 1.21 to 1.27, P < 0.001). There were net reductions in risk factor values up to six years after the check for BMI (-0.30, -0.39 to -0.20 Kg/m2, P < 0.001), SBP (-1.43, -1.70 to -1.16 mm Hg, P < 0.001), and smoking (17% in health check participants versus 25% in controls; odds ratio 0.90, 0.87 to 0.94, P < 0.001). The main study limitation was that residual confounding may be present because randomisation was not employed; health check-associated measurement introduced differential recording that might cause bias. CONCLUSIONS Our results suggest that people who take up a health check generally have lower risk factor values than controls and are more likely to receive risk factor interventions. Risk factor values show net reductions up to six years following a health check in BMI, blood pressure, and smoking, which may be of public health importance.
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18
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Strongman H, Williams R, Meeraus W, Murray‐Thomas T, Campbell J, Carty L, Dedman D, Gallagher AM, Oyinlola J, Kousoulis A, Valentine J. Limitations for health research with restricted data collection from UK primary care. Pharmacoepidemiol Drug Saf 2019; 28:777-787. [PMID: 30993808 PMCID: PMC6618795 DOI: 10.1002/pds.4765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/30/2018] [Accepted: 02/14/2019] [Indexed: 11/12/2022]
Abstract
Purpose UK primary care provides a rich data source for research. The impact of proposed data collection restrictions is unknown. This study aimed to assess the impact of restricting the scope of electronic health record (EHR) data collection on the ability to conduct research. The study estimated the consequences of restricted data collection on published Clinical Practice Research Datalink studies from high impact journals or referenced in clinical guidelines. Methods A structured form was used to systematically analyse the extent to which individual studies would have been possible using a database with data collection restrictions in place: (1) retrospective collection of specified diseases only; (2) retrospective collection restricted to a 6‐ or 12‐year period; (3) prospective and retrospective collection restricted to non‐sensitive data. Outcomes were categorised as unfeasible (not reproducible without major bias); compromised (feasible with design modification); or unaffected. Results Overall, 91% studies were compromised with all restrictions in place; 56% studies were unfeasible even with design modification. With restrictions on diseases alone, 74% studies were compromised; 51% were unfeasible. Restricting collection to 6/12 years had a major impact, with 67 and 22% of studies compromised, respectively. Restricting collection of sensitive data had a lesser but marked impact with 10% studies compromised. Conclusion EHR data collection restrictions can profoundly reduce the capacity for public health research that underpins evidence‐based medicine and clinical guidance. National initiatives seeking to collect EHRs should consider the implications of restricting data collection on the ability to address vital public health questions.
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Affiliation(s)
| | | | | | | | | | - Lucy Carty
- Clinical Practice Research Datalink (CPRD)MHRALondonUK
| | - Daniel Dedman
- Clinical Practice Research Datalink (CPRD)MHRALondonUK
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19
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Chang KCM, Vamos EP, Palladino R, Majeed A, Lee JT, Millett C. Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis. J Epidemiol Community Health 2018; 73:11-18. [PMID: 30282645 DOI: 10.1136/jech-2018-210961] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/27/2018] [Accepted: 08/31/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND We assessed impacts of a large, nationwide cardiovascular disease (CVD) risk assessment and management programme on sociodemographic group inequalities in (1) early identification of hypertension, type 2 diabetes (T2D) and chronic kidney disease (CKD); and (2) management of global CVD risk among high-risk individuals. METHODS We obtained retrospective electronic medical records from the Clinical Practice Research Datalink for a randomly selected sample of 138 788 patients aged 40-74 years without known CVD or diabetes, who were registered with 462 practices between 2009 and 2013. We estimated programme impact using a difference-in-differences matching analysis that compared changes in outcome over time between attendees and non-attendees. RESULTS National Health Service Health Check attendance was 21.4% (29 672/138 788). A significantly greater number of hypertension and T2D incident cases were identified in men than women (eg, an additional 4.02%, 95% CI 3.65% to 4.39%, and 2.08%, 1.81% to 2.35% cases of hypertension in men and women, respectively). A significantly greater number of T2D incident cases were identified among attendees living in the most deprived areas, but no differences were found for hypertension and CKD across socioeconomic groups. No major differences in CVD risk management were observed between sociodemographic subgroups (eg, programme impact on 10-year CVD risk score was -1.13%, -1.48% to -0.78% in male and -1.53%, -2.36% to -0.71% in female attendees). CONCLUSION During 2009-2013, the programme had low attendance and small overall impacts on early identification of disease and risk management. The age, sex and socioeconomic subgroups appeared to have derived similar level of benefits, leaving existing inequalities unchanged. These findings highlight the importance of population-wide interventions to address inequalities in CVD outcomes.
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Affiliation(s)
- Kiara C-M Chang
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Raffaele Palladino
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - John Tayu Lee
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK.,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
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20
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What are the determinants for individuals to undergo cardiovascular disease health checks? A cross sectional survey. PLoS One 2018; 13:e0201931. [PMID: 30092064 PMCID: PMC6085058 DOI: 10.1371/journal.pone.0201931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/24/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is a need to improve public's participation in health checks for early identification of individuals at high risk of CVD for prevention. The objective of this study is to identify significant determinants associated with individuals' intention to undergo CVD health checks. These determinants could be used to develop effective strategies to improve CVD health check participation. METHODS This was a cross sectional survey using mall intercept interviews. It was carried out in a hypermarket surrounded by housing estates with a population of varying socioeconomic backgrounds. Inclusion criteria were Malaysian nationality and age 30 years and older. The validated CVD health check questionnaire was used to assess participants' intention and the determinants that influenced their intention to undergo CVD health checks. RESULTS A total of 413 participants were recruited. The median age of the participants was 45 years (IQR 17 years) and 60% of them were female. Participants indicated they were likely (45.0%) or very likely (38.7%) to undergo CVD health checks while 16.2% were not sure, unlikely or very unlikely to undergo health checks. Using ordinal regression analysis, perception of benefits, drawbacks of CVD health checks, perception of external barriers and readiness to handle outcomes following CVD health checks were the significant determinants of individuals' intention to undergo CVD health checks. CONCLUSIONS To improve individuals' participation in CVD health checks, we need to develop strategies to address their perception of benefits and drawbacks of CVD health checks, the perceived external barriers and their readiness to handle outcomes following CVD health checks.
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21
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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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22
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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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23
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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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24
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Gulliford M. Access to primary care and public health. LANCET PUBLIC HEALTH 2017; 2:e532-e533. [DOI: 10.1016/s2468-2667(17)30218-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
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25
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Mills K, Harte E, Martin A, MacLure C, Griffin SJ, Mant J, Meads C, Saunders CL, Walter FM, Usher-Smith JA. Views of commissioners, managers and healthcare professionals on the NHS Health Check programme: a systematic review. BMJ Open 2017; 7:e018606. [PMID: 29146658 PMCID: PMC5695333 DOI: 10.1136/bmjopen-2017-018606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To synthesise data concerning the views of commissioners, managers and healthcare professionals towards the National Health Service (NHS) Health Check programme in general and the challenges faced when implementing it in practice. DESIGN A systematic review of surveys and interview studies with a descriptive analysis of quantitative data and thematic synthesis of qualitative data. DATA SOURCES An electronic literature search of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the International Standard Randomised Controlled Trial Number registry from 1 January 1996 to 9 November 2016 with no language restriction and manual screening of reference lists of all included papers. INCLUSION CRITERIA Primary research reporting views of commissioners, managers or healthcare professionals on the NHS Health Check programme and its implementation in practice. RESULTS Of 18 524 citations, 15 articles met the inclusion criteria. There was evidence from both quantitative and qualitative studies that some commissioners and general practice (GP) healthcare professionals were enthusiastic about the programme, whereas others raised concerns around inequality of uptake, the evidence base and cost-effectiveness. In contrast, those working in pharmacies were all positive about programme benefits, citing opportunities for their business and staff. The main challenges to implementation were: difficulties with information technology and computer software, resistance to the programme from some GPs, the impact on workload and staffing, funding and training needs. Inadequate privacy was also a challenge in pharmacy and community settings, along with difficulty recruiting people eligible for Health Checks and poor public access to some venues. CONCLUSIONS The success of the NHS Health Check Programme relies on engagement by those responsible for its commissioning, management and delivery. Recognising and addressing the challenges identified in this review, in particular the concerns of GPs, are important for the future of the programme.
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Affiliation(s)
- Katie Mills
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Emma Harte
- RAND Europe, Westbrook Centre, Cambridge, UK
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Simon J Griffin
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
| | - Jonathan Mant
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Catherine Meads
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
| | - Catherine L Saunders
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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26
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Robson J, Dostal I, Madurasinghe V, Sheikh A, Hull S, Boomla K, Griffiths C, Eldridge S. NHS Health Check comorbidity and management: an observational matched study in primary care. Br J Gen Pract 2017; 67:e86-e93. [PMID: 27993901 PMCID: PMC5308122 DOI: 10.3399/bjgp16x688837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The NHS Health Check programme completed its first 5 years in 2014, identifying those at highest risk of cardiovascular disease and new comorbidities, and offering behavioural change support and treatment. AIM To describe the coverage and impact of this programme on cardiovascular risk management and identification of new comorbidities. DESIGN AND SETTING Observational 5-year study from April 2009 to March 2014, in 139 of 143 general practices in three clinical commissioning groups (CCGs) in east London. METHOD A matched analysis compared comorbidity in NHS Health Check attendees and non-attendees. RESULTS A total of 252 259 adults aged 40-74 years were eligible for an NHS Health Check and, of these, 85 122 attended in 5 years. Attendance increased from 7.3% (10 900/149 867) in 2009 to 17.0% (18 459/108 525) in 2013 to 2014, representing increasing coverage from 36.4% to 85.0%. Attendance was higher in the more deprived quintiles and among South Asians. Statins were prescribed to 11.5% of attendees and 8.2% of non-attendees. In a matched analysis, newly-diagnosed comorbidity was more likely in attendees than non-attendees, with odds ratios for new diabetes 1.30 (95% confidence interval [CI] = 1.21 to 1.39), hypertension 1.50 (95% CI = 1.43 to 1.57), and chronic kidney disease 1.83 (95% CI = 1.52 to 2.21). CONCLUSION The NHS Health Check programme provision in these CCGs was equitable, with recent coverage of 85%. Statins were 40% more likely to be prescribed to attendees than non-attendees, providing estimated absolute benefits of public health importance. More new cases of diabetes, hypertension, and chronic kidney disease were identified among attendees than a matched group of non-attendees.
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Affiliation(s)
- John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Isabel Dostal
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | | | - Aziz Sheikh
- Centre for Primary Care and Public Health, eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh
| | - Sally Hull
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Kambiz Boomla
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London
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27
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Geue C, Lewsey JD, MacKay DF, Antony G, Fischbacher CM, Muirie J, McCartney G. Scottish Keep Well health check programme: an interrupted time series analysis. J Epidemiol Community Health 2016; 70:924-9. [PMID: 27072868 PMCID: PMC5013158 DOI: 10.1136/jech-2015-206926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Effective interventions are available to reduce cardiovascular risk. Recently, health check programmes have been implemented to target those at high risk of cardiovascular disease (CVD), but there is much debate whether these are likely to be effective at population level. This paper evaluates the impact of wave 1 of Keep Well, a Scottish health check programme, on cardiovascular outcomes. METHODS Interrupted time series analyses were employed, comparing trends in outcomes in participating and non-participating practices before and after the introduction of health checks. Health outcomes are defined as CVD mortality, incident hospitalisations and prescribing of cardiovascular drugs. RESULTS After accounting for secular trends and seasonal variation, coronary heart disease mortality and hospitalisations changed by 0.4% (95% CI -5.2% to 6.3%) and -1.1% (-3.4% to 1.3%) in Keep Well practices and by -0.3% (-2.7% to 2.2%) and -0.1% (-1.8% to 1.7%) in non-Keep Well practices, respectively, following the intervention. Adjusted changes in prescribing in Keep Well and non-Keep Well practices were 0.4% (-10.4% to 12.5%) and -1.5% (-9.4% to 7.2%) for statins; -2.5% (-12.3% to 8.4%) and -1.6% (-7.1% to 4.3%) for antihypertensive drugs; and -0.9% (-6.5% to 5.0%) and -2.4% (-10.1% to 6.0%) for antiplatelet drugs. CONCLUSIONS Any impact of the Keep Well health check intervention on CVD outcomes and prescribing in Scotland was very small. Findings do not support the use of the screening approach used by current health check programmes to address CVD. We used an interrupted time series method, but evaluation methods based on randomisation are feasible and preferable and would have allowed more reliable conclusions. These should be considered more often by policymakers at an early stage in programme design when there is uncertainty regarding programme effectiveness.
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Affiliation(s)
- Claudia Geue
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - James D Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | | | - Grace Antony
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Colin M Fischbacher
- Information Services Division (ISD), NHS National Services Scotland, Edinburgh, UK
| | - Jill Muirie
- Glasgow Centre for Population Health, Glasgow, UK
| | - Gerard McCartney
- Department of Public Health Observatory, NHS Health Scotland, Glasgow, UK
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