Uptake of the NHS Health Check programme in an urban setting

Abstract

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.

Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study

“…The large variation in coverage present is consistent with previous studies and may reflect the phased initial roll-out of the programme. [21][22][23] Our findings are consistent with previous local studies which found higher attendance in older patients and in those with a family history of CHD. [22][23][24] Previous studies suggest attendance may be higher in ethnic minority groups but have produced mixed findings on whether men or women were more likely to attend.…”

“…[21][22][23] Our findings are consistent with previous local studies which found higher attendance in older patients and in those with a family history of CHD. [22][23][24] Previous studies suggest attendance may be higher in ethnic minority groups but have produced mixed findings on whether men or women were more likely to attend. [22][23][24] We identified no significant gender differences in coverage using national data.…”

“…[22][23][24] Previous studies suggest attendance may be higher in ethnic minority groups but have produced mixed findings on whether men or women were more likely to attend. [22][23][24] We identified no significant gender differences in coverage using national data. Our large sample size allowed us to assess coverage by ethnic group in greater detail than previous studies.…”

Enhanced invitation methods and uptake of health checks in primary care: randomised controlled trial and cohort study using electronic health records

“…37 Associations between deprivation and uptake have been less consistent. Higher deprivation has been linked with lower uptake, 61 which is consistent with evidence from other screening programmes, 16 whereas some studies have reported higher uptake in more deprived areas 27 or no relationship. 25 In the same trial, 25 the proportion of health checks and demographic characteristics were compared between patients who received a postal invitation and those whose health checks were performed opportunistically.…”

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

“…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].…”