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Duddy C, Gadsby E, Hibberd V, Krska J, Wong G. What happens after an NHS Health Check? A survey and realist review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-133. [PMID: 37830173 DOI: 10.3310/rgth4127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Background The National Health Service Health Check in England aims to provide adults aged 40 to 74 with an assessment of their risk of developing cardiovascular disease and to offer advice to help manage and reduce this risk. The programme is commissioned by local authorities and delivered by a range of providers in different settings, although primarily in general practices. This project focused on variation in the advice, onward referrals and prescriptions offered to attendees following their health check. Objectives (1) Map recent programme delivery across England via a survey of local authorities; (2) conduct a realist review to enable understanding of how the National Health Service Health Check programme works in different settings, for different groups; (3) provide recommendations to improve delivery. Design Survey of local authorities and realist review of the literature. Review methods Realist review is a theory-driven, interpretive approach to evidence synthesis that seeks to explain why, when and for whom outcomes occur. We gathered published research and grey literature (including local evaluation documents and conference materials) via searching and supplementary methods. Extracted data were synthesised using a realist logic of analysis to develop an understanding of important contexts that affect the delivery of National Health Service Health Checks, and underlying mechanisms that produce outcomes related to our project focus. Results Our findings highlight the variation in National Health Service Health Check delivery models across England. Commissioners, providers and attendees understand the programme's purpose in different ways. When understood primarily as an opportunity to screen for disease, responsibility for delivery and outcomes rests with primary care, and there is an emphasis on volume of checks delivered, gathering essential data and communicating risk. When understood as an opportunity to prompt and support behaviour change, more emphasis is placed on delivery of advice and referrals to 'lifestyle services'. Practical constraints limit what can be delivered within the programme's remit. Public health funding restricts delivery options and links with onward services, while providers may struggle to deliver effective checks when faced with competing priorities. Attendees' responses to the programme are affected by features of delivery models and the constraints they face within their own lives. Limitations Survey response rate lower than anticipated; review findings limited by the availability and quality of the literature. Conclusions and implications The purpose and remit of the National Health Service Health Check programme should be clarified, considering prevailing attitudes about its value (especially among providers) and what can be delivered within existing resources. Some variation in delivery is likely to be appropriate to meet local population needs, but lack of clarity for the programme contributes to a 'postcode lottery' effect in the support offered to attendees after a check. Our findings raise important questions about whether the programme itself and services that it may feed into are adequately resourced to achieve positive outcomes for attendees, and whether current delivery models may produce inequitable outcomes. Future work Policy-makers and commissioners should consider the implications of the findings of this project; future research should address the relative scarcity of studies focused on the end of the National Health Service Health Check pathway. Study registration PROSPERO registration CRD42020163822. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR129209).
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Affiliation(s)
- Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Erica Gadsby
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Vivienne Hibberd
- Public Involvement in Pharmacy Studies Group, Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham Maritime, UK
| | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham Maritime, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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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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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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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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Forster AS, Burgess C, Dodhia H, Fuller F, Miller J, McDermott L, Gulliford MC. Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records. J Public Health (Oxf) 2016; 38:552-559. [PMID: 26350481 PMCID: PMC5072161 DOI: 10.1093/pubmed/fdv119] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To evaluate the effect of NHS Health Checks on cardiovascular risk factor detection and inequalities. METHODS Matched cohort study in the Clinical Practice Research Datalink, including participants who received a health check in England between 1 April 2010 and 31 March 2013, together with matched control participants, with linked deprivation scores. RESULTS There were 91 618 eligible participants who received a health check, of whom 75 123 (82%) were matched with 182 245 controls. After the health check, 90% of men and 92% of women had complete data for blood pressure, total cholesterol, smoking and body mass index; a net 51% increase (P < 0.001) over controls. After the check, gender and deprivation inequalities in recording of all risk factors were lower than for controls. Net increase in risk factor detection was greater for hypercholesterolaemia (men +33%; women +32%) than for obesity (men +8%; women +4%) and hypertension in men only (+5%) (all P < 0.001). Detection of smoking was 5% lower in health check participants than controls (P < 0.001). Over 4 years, statins were prescribed to 11% of health -check participants and 7.6% controls (hazard ratio 1.58, 95% confidence interval 1.53-1.63, P < 0.001). CONCLUSION NHS Health Checks are associated with increased detection of hypercholesterolaemia, and to a lesser extent obesity and hypertension, but smokers may be under-represented.
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Affiliation(s)
- Alice S Forster
- 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
| | - Hiten Dodhia
- Public Health Directorate, London Boroughs of Lambeth and Southwark, London, UK
| | - Frances Fuller
- Department of Public Health, London Borough of Lewisham, London, UK
| | - Jane Miller
- Department of Public Health, London Borough of Lewisham, London, UK
| | - Lisa McDermott
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Carter P, Bodicoat DH, Davies MJ, Ashra NB, Riley D, Joshi N, Farooqi A, Browne I, Khunti K. A retrospective evaluation of the NHS Health Check Programme in a multi-ethnic population. J Public Health (Oxf) 2015; 38:534-542. [PMID: 26315996 DOI: 10.1093/pubmed/fdv115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The NHS Health Check Programme was introduced in 2009 to improve primary prevention of coronary heart disease, stroke, diabetes and chronic kidney disease; however, there has been debate regarding the impact. We present a retrospective evaluation of Leicester City Clinical Commissioning Group. METHODS Data are reported on diagnosis of type 2 diabetes, hypertension, chronic kidney disease, high risk of type 2 diabetes and high risk of cardiovascular disease. Data on management following the Health Check are also reported. RESULTS Over a 5-year period, 53 799 health checks were performed, 16 388 (30%) people were diagnosed with at least one condition when diagnosis of being at high risk of cardiovascular disease was defined as ≥20%. This figure increased to 43% when diagnosis of high cardiovascular risk ≥10% was included. Of the 3063 (5.7%) individuals diagnosed with type 2 diabetes, 54% were prescribed metformin and 26% were referred for structured education. Of the 5797 (10.8%) individuals diagnosed at high risk of cardiovascular disease (≥20%), 64% were prescribed statins. CONCLUSIONS A high proportion of new cases of people at risk of cardiovascular disease were identified by the NHS Health Check Programme. Data suggest that this has translated into appropriate preventative measures.
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Affiliation(s)
- P Carter
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, The University of Leicester, Leicester LE5 4PW, UK
| | - D H Bodicoat
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, The University of Leicester, Leicester LE5 4PW, UK
| | - M J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, The University of Leicester, Leicester LE5 4PW, UK
| | - N B Ashra
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, The University of Leicester, Leicester LE5 4PW, UK
| | - D Riley
- Leicester City Commissioning Group, Leicester LE1 6NB, UK
| | - N Joshi
- Leicester City Commissioning Group, Leicester LE1 6NB, UK
| | - A Farooqi
- Leicester City Commissioning Group, Leicester LE1 6NB, UK
| | - I Browne
- Leicester City Council, Leicester LE1 6NB, UK
| | - K Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, The University of Leicester, Leicester LE5 4PW, UK
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Forster AS, Burgess C, McDermott L, Wright AJ, Dodhia H, Conner M, Miller J, Rudisill C, Cornelius V, Gulliford MC. Enhanced invitation methods to increase uptake of NHS health checks: study protocol for a randomized controlled trial. Trials 2014; 15:342. [PMID: 25174568 PMCID: PMC4156615 DOI: 10.1186/1745-6215-15-342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND NHS Health Checks is a new program for primary prevention of heart disease, stroke, diabetes, chronic kidney disease, and vascular dementia in adults aged 40 to 74 years in England. Individuals without existing cardiovascular disease or diabetes are invited for a Health Check every 5 years. Uptake among those invited is lower than anticipated. METHOD The project is a three-arm randomized controlled trial to test the hypothesis that enhanced invitation methods, using the Question-Behaviour Effect (QBE), will increase uptake of NHS Health Checks compared with a standard invitation. Participants comprise individuals eligible for an NHS Health Check registered in two London boroughs. Participants are randomized into one of three arms. Group A receives the standard NHS Health Check invitation letter, information sheet, and reminder letter at 12 weeks for nonattenders. Group B receives a QBE questionnaire 1 week before receiving the standard invitation, information sheet, and reminder letter where appropriate. Group C is the same as Group B, but participants are offered a £5 retail voucher if they return the questionnaire. Participants are randomized in equal proportions, stratified by general practice. The primary outcome is uptake of NHS Health Checks 6 months after invitation from electronic health records. We will estimate the incremental health service cost per additional completed Health Check for trial groups B and C versus trial arm A, as well as evaluating the impact of the QBE questionnaire, and questionnaire plus voucher, on the socioeconomic inequality in uptake of Health Checks.The trial includes a nested comparison of two methods for implementing allocation, one implemented manually at general practices and the other implemented automatically through the information systems used to generate invitations for the Health Check. DISCUSSION The research will provide evidence on whether asking individuals to complete a preliminary questionnaire, by using the QBE, is effective in increasing uptake of Health Checks and whether an incentive alters questionnaire return rates as well as uptake of Health Checks. The trial interventions can be readily translated into routine service delivery if they are shown to be cost-effective. TRIAL REGISTRATION Current Controlled Trials ISRCTN42856343. Date registered: 21.03.2013.
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Mackie P, Sim F. Two weeks in Geneva. Public Health 2014; 128:397-8. [PMID: 24856201 DOI: 10.1016/j.puhe.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- P Mackie
- The Royal Society for Public Health, John Snow House, 59 Mansell Street, London E1 8AN, UK.
| | - F Sim
- The Royal Society for Public Health, John Snow House, 59 Mansell Street, London E1 8AN, UK
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