Implementation of the NHS Health Checks programme: baseline assessment of risk factor recording in an urban culturally diverse setting

Dalton, Andrew; Bottle, Alex; Okoro, Cyprian; Majeed, Azeem; Millett, Christopher

doi:10.1093/fampra/cmq068

Cited by 29 publications

(50 citation statements)

References 20 publications

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“…Previous work suggests NHS Health Check have considerable workload implications for primary care 29,30 and there have been concerns over the costeffectiveness of the programme. 31 Department of Health modelling assumes 75% of patients attend, with 85% uptake of statins.…”

Section: Implications For Future Research or Clinical Practicementioning

confidence: 99%

Uptake of the NHS Health Check programme in an urban setting

et al. 2013

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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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Section: Implications For Future Research or Clinical Practicementioning

confidence: 99%

Uptake of the NHS Health Check programme in an urban setting

et al. 2013

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“…Nationally reported data for health check uptake, which include both invited and opportunistic health checks, show that the number of health checks performed as a percent of the number invited is now about 46% in England [13]. Local evaluations have confirmed a pattern of low uptake of health checks [14][15][16] but there is considerable variation between different areas. In the two London boroughs included in this study, nationally reported data now show health check uptake of 37% and 23%, respectively [13].…”

Section: Introductionmentioning

confidence: 99%

Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care

McDermott

Cornelius

Wright

et al. 2018

Annals of Behavioral Medicine

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Background Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake. Purpose The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks. Methods We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance. Results 12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41%); QBE questionnaire, 630 / 3,988 (15.80%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85%). Difference following QBE questionnaire, 1.43% (95% confidence interval −0.12 to 2.97%, p = .070); following QBE questionnaire and financial incentive, 1.52% (−0.03 to 3.07%, p = .054). Conclusions Uptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.

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“…Data were extracted as part of the NHS Health Check programme, using Oberoi primary prevention software. We used data from the baseline of the programme, 5 extracted between December 2008 and December 2009. Briefly, data consist of demographic, anthropometric and clinical data relating to cardiovascular risk for patients registered in general practice, aged 35-74 years without diagnosed coronary heart disease or stroke; Table 1 lists the variables extracted.…”

Section: Data Sourcementioning

confidence: 99%

“…17 The call for targeted screening is not a new one and there is growing evidence to support this approach, 18 a recent case-control study has shown the strengths of using existing administrative data in the USA to predict stoke. 19 CVD risk factor recording is not complete in patient medical records, 5 but partial data maintains accurate risk prediction. 20 …”

Section: What Is Already Known On This Topic?mentioning

confidence: 99%

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The comparison of cardiovascular risk scores using two methods of substituting missing risk factor data in patient medical records

Dalton

Bottle²,

Soljak³

et al. 2011

Journal of Innovation in Health Informatics

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Background Targeted screening for cardiovascular disease (CVD) can be carried out using existing data from patient medical records. However, electronic medical records in UK general practice contain missing risk factor data for which values must be estimated to produce risk scores. Objective To compare two methods of substituting missing risk factor data; multiple imputation and the use of default National Health Survey values. Methods We took patient-level data from patients in 70 general practices in Ealing, North West London. We substituted missing risk factor data using the two methods, applied two risk scores (QRISK2 and JBS2) to the data and assessed differences between methods. Results Using multiple imputation, mean CVD risk scores were similar to those using default

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Implementation of the NHS Health Checks programme: baseline assessment of risk factor recording in an urban culturally diverse setting

Abstract: The workload implications of the NHS Health Checks programme for general practices in England are substantial. There are considerable variations in risk factor recording between practices and between age, gender and ethnic groups.

Cited by 29 publications

References 20 publications

Uptake of the NHS Health Check programme in an urban setting

Uptake of the NHS Health Check programme in an urban setting

Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care

The comparison of cardiovascular risk scores using two methods of substituting missing risk factor data in patient medical records

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