Background. The NHS Health Check programme aims to improve prevention, early diagnosis and management of cardiovascular disease (CVD) in England. High and equitable uptake is essential for the programme to effectively reduce the CVD burden. Objectives. Assessing the impact of a local financial incentive scheme on uptake and statin prescribing in the first 2 years of the programme.Methods. Cross-sectional study using data from electronic medical records of general practices in Hammersmith and Fulham, London on all patients aged 40-74 years. We assessed uptake of complete Health Check, exclusion of patients from the programme (exception reporting) and statin prescriptions in patients confirmed with high CVD risk.Results. The Health Check uptake was 32.7% in Year 1 and 20.0% in Year 2. Older patients had higher uptake of Health Check than younger (65-to 74-year-old patients: Year 1 adjusted odds ratio (AOR) 2.05 (1.67-2.52) & Year 2 AOR 2.79 (2.49-3.12) compared with 40-to 54-year-old patients). The percentage of confirmed high risk patients prescribed a statin was 17.7% before and 52.9% after the programme. There was a marked variation in Health Check uptake, exception reporting and statin prescribing between practices.Conclusions. Uptake of the Health Check was low in the first year in patients with estimated high risk despite financial incentives to general practices; although this matched the national required rate in second year. Further evaluations for cost and clinical effectiveness of the programme are needed to clarify whether this spending is appropriate, and to assess the impact of financial incentives on programme performance.

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NHS Health Check coverage during 2011-12 was lower than the government projection of 18% coverage. Coverage must be increased through concerted multi-disciplinary strategies, for the programme to improve cardiovascular health in England. Considerable variation in participation between PCTs warrants attention, with enhanced support for poor performers.

ObjectivesTo assess the completeness of cardiovascular disease (CVD) risk factor recording and levels of risk factors in patients eligible for the NHS Health Check.DesignCross-sectional study.SettingTwenty-eight general practices located in Hammersmith and Fulham, London, UK.Participants42,306 patients aged 40 to 74 years without existing cardiovascular disease or diabetes.Main Outcome MeasuresMeasurement and level of CVD risk factors: blood pressure, cholesterol, body mass index (BMI), blood glucose and smoking status.ResultsThere was a high recording of smoking status (86.1%) and blood pressure (82.5%); whilst BMI, cholesterol and glucose recording was lower. There was large variation in BMI, cholesterol, glucose recording between practices (29.7–91.5% for BMI). Women had significantly better risk factor recording than men (AOR = 1.70 [1.61–1.80] for blood pressure). All risk factors were better recorded in the least deprived patient group (AOR = 0.79 [0.73–0.85] for blood pressure) and patients with diagnosed hypertension (AOR = 7.24 [6.67–7.86] for cholesterol). Risk factor recording varied considerably between practices but was more strongly associated with patient than practice level characteristics. Age-adjusted levels of cholesterol and BMI were not significantly different between men and women. More men had raised blood glucose, blood pressure and BMI than women (29.7% [29.1–30.4] compared to 19.8% [19.3–20.3] for blood pressure).ConclusionsBefore the NHS Health Check, CVD risk factor recording varied considerably by practice and patient characteristics. We identified significant elevated levels of raised CVD risk factors in the population eligible for a Health Check, which will require considerable work to manage.

The issue of maternal mortality in the developing world is still a major concern for health planners and policymakers. This systematic review was done keeping in view the high maternal mortality rates in Nigeria, to identify the major direct and indirect causes and thus enable us to understand the gaps between what is and what ought to be. For this purpose, the published work was reviewed by searching the PubMed and BioMed Central databases for retrospective maternal mortality reviews and autopsies after the year 2000. Of 69 articles, 11 full-text articles were reviewed and six of them were finally included in the study. Eclampsia, pre-eclampsia, and hemorrhage were reported to be the most common direct causes of maternal mortality, all of which are preventable by simple maneuvers like regular antenatal checkups, early detection, presence of trained birth attendants to assist with the delivery, easy access to health facilities, etc. There is a need to increase the utilization of antenatal care services to improve the number of booked patients and ensure the provision of essential medicines and safe blood transfusions to reduce the current high mortality rates.