NHS Health Check comorbidity and management: an observational matched study in primary care

Robson, John; Dostal, Isabel; Madurasinghe, Vichithranie; Sheikh, Aziz; Hull, Sally; Boomla, Kambiz; Griffiths, Chris; Eldridge, Sandra

doi:10.3399/bjgp16x688837

Cited by 27 publications

(30 citation statements)

References 37 publications

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“…British Journal of General Practice. 2017;67:(655): e86-e93 [ 38 ]. 252,259 patients invited for NHS Health Checks in 3 CCGs in East London Only non-modifiable influences on behaviour reported Routinely collected data Burgess, C., A.J.…”

Section: Resultsmentioning

confidence: 99%

Influences on NHS Health Check behaviours: a systematic review

et al. 2020

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Background National Health Service Health Checks were introduced in 2009 to reduce cardiovascular disease (CVD) risks and events. Since then, national evaluations have highlighted the need to maximise the programme’s impact by improving coverage and outputs. To address these challenges it is important to understand the extent to which positive behaviours are influenced across the NHS Health Check pathway and encourage the promotion or minimisation of behavioural facilitators and barriers respectively. This study applied behavioural science frameworks to: i) identify behaviours and actors relevant to uptake, delivery and follow up of NHS Health Checks and influences on these behaviours and; ii) signpost to example intervention content. Methods A systematic review of studies reporting behaviours related to NHS Health Check-related behaviours of patients, health care professionals (HCPs) and commissioners. Influences on behaviours were coded using theory-based models: COM-B and Theoretical Domains Framework (TDF). Potential intervention types and behaviour change techniques (BCTs) were suggested to target key influences. Results We identified 37 studies reporting nine behaviours and influences for eight of these. The most frequently identified influences were physical opportunity including HCPs having space and time to deliver NHS Health Checks and patients having money to adhere to recommendations to change diet and physical activity. Other key influences were motivational, such as beliefs about consequences about the value of NHS Health Checks and behaviour change, and social, such as influences of others on behaviour change. The following techniques are suggested for websites or smartphone apps: Adding objects to the environment, e.g. provide HCPs with electronic schedules to guide timely delivery of Health Checks to target physical opportunity, Social support (unspecified), e.g. include text suggesting patients to ask a colleague to agree in advance to join them in taking the ‘healthy option’ lunch at work; Information about health consequences, e.g. quotes and/or videos from patients talking about the health benefits of changes they have made. Conclusions Through the application of behavioural science we identified key behaviours and their influences which informed recommendations for intervention content. To ascertain the extent to which this reflects existing interventions we recommend a review of relevant evidence.

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Section: Resultsmentioning

confidence: 99%

Influences on NHS Health Check behaviours: a systematic review

et al. 2020

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“…It is difficult to ascertain whether NHS Health Checks attract patients at highest risk of CVD, as recommendations in some areas have been to invite higher risk patients first [ 19 ]. Whilst others have found non-attenders to have a higher set of risk factors for CVD compared to attenders [ 20 ], several studies, including ours have found a greater rate of attendance in older patients [ 21 ], a population more likely to have a higher set of risk factors for CVD.…”

Section: Discussionmentioning

confidence: 99%

NHS health checks: a cross- sectional observational study on equity of uptake and outcomes

Coghill

Garside

Montgomery

et al. 2018

BMC Health Serv Res

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BackgroundThe National Health Checks programme aims to reduce the incidence of cardiovascular diseases and health inequalities in England. We assessed equity of uptake and outcomes from NHS Health Checks in general practices in Bristol, UK.MethodsA cross-sectional study using patient-level data, from 38 general practices. We descriptively analysed the socioeconomic status (SES) of patients invited and the SES and ethnicity of those attending. Logistic regression was used to test associations between invitation and attendance, with population characteristics.ResultsBetween June 2010 to October 2014, 31,881 patients were invited, and 13,733 NHS Health Checks completed. 47% of patients invited from the three least and 39% from the two most-deprived index of multiple deprivation quintiles, completed a Check. Proportions of invited patients, by ethnicity were 64% non-black and Asian and 31% black and Asian. Men were less likely to attend than women (OR 0.73, 95% confidence interval 0.67 to 0.80), as were patients ≤ 49 compared to ≥ 70 years (OR 0.40, 95% confidence interval 0.65 to 0.83).After controlling for SES and population characteristics, compared to patients with low CVD risk, high risk patients were more likely to be prescribed cardiovascular drugs (OR 6.2, 95% confidence interval 4.51 to 8.40). Compared to men, women (OR 01.18, 95% confidence interval 1.03 to 1.35) were more likely to be prescribed cardiovascular drugs, as were those ≤ 49 years (50–59 years, OR 1.42, 95% confidence intervals 1.13–1.79, 60–69 years, OR 1.60, 95% confidence intervals, 1.22–2.10, ≥ 70 years, OR 1.64, 95% confidence intervals, 1.14 to 2.35).Controlling for population characteristics, the following groups were most likely to be referred to lifestyle services: younger women (OR 2.22, 95% CI 1.69 to 2.94), those in the most deprived IMD quintile (OR 3.22, 95% CI 1.63 to 6.36) and those at highest risk of CVD (OR, 2.77, 95% CI 1.91 to 4.02).ConclusionsWe found no statistically significant evidence of inequity in attendance for an NHS Health Check by SES. Being older or a woman were associated with better attendance. Targeting men, younger patients and ethnic minority groups may improve equity in uptake for NHS Health Checks.

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“…Previous research has shown that the risk of a fatal coronary event associated with FH is greatest in the 20-39 year age group [23]. The mean age of subjects in our study was 42 years, and may partly be due to the fact that previously asymptomatic individuals become identified in primary care during the UK NHS health check, which is offered to adults aged between 40 and 74 years [24]. In addition, in patients less than 40 years, a clinical diagnosis of FH in primary care may only be recognised after the first diagnosis of CVD.…”

Section: Figmentioning

confidence: 91%