Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis

Chang, Kiara; Lee, John Tayu; Vámos, Eszter; Soljak, Michael; Johnston, Desmond G.; Khunti, Kamlesh; Majeed, Azeem; Millett, Christopher

doi:10.1503/cmaj.151201

Cited by 60 publications

(96 citation statements)

References 41 publications

(51 reference statements)

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“…28,29 Public Health England is addressing improvements. [30][31][32] This study took place in three neighbouring inner-London CCGs with some of the most ethnically diverse and socially deprived populations in the UK. Out of a population of 950 000, 50% are from ethnic minority groups, of which 30% are South Asian and 10% are black African-Caribbean.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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BackgroundThe 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.AimTo describe the coverage and impact of this programme on cardiovascular risk management and identification of new comorbidities.Design and settingObservational 5-year study from April 2009 to March 2014, in 139 of 143 general practices in three clinical commissioning groups (CCGs) in east London.MethodA matched analysis compared comorbidity in NHS Health Check attendees and non-attendees.ResultsA 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).ConclusionThe 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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Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…med. (2018) XX: [1][2][3][4][5][6][7][8][9][10][11][12]deprived quintile for England. There were 35.9% White, 19.5% Black African / Caribbean and 19.6% mixed ethnicity participants.…”

Section: Main Trial Resultsmentioning

confidence: 99%

“…The health check program was judged to be potentially cost-effective if 75% of eligible participants were to take up the offer of a check [7]. Health checks remain controversial because of the questionable evidence for the effectiveness of a health check program [8,9], the variable organization and delivery of the program [10] and the small effects it may achieve [11]. Nevertheless, maximizing uptake of health checks remains important for realizing the aims of the health check program and ensuring that the existing health inequalities are not perpetuated.…”

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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“…We used a robust difference-in-differences matching model to account for the underlying trends in cardiovascular risk over time. 3 We acknowledged the potential limitation in using multiple imputation to address missing data, but our findings using a complete case analysis (i.e., only considered non-attendees with complete risk factor data) were broadly similar. 3 In response to their concerns about not basing our analysis on patient attendance identified by a Read code, we have compared risk reduction in attendees identified by Read codes and nonattendees (both without a Read code or algorithm-identified attendance).…”

mentioning

confidence: 74%

“…2 Our findings also suggest that the NHS Health Check may have improved detection of hypertension, type 2 diabetes mellitus and chronic kidney disease. 3 A recent microsimulation study performed by Kypridemos and colleagues 5 has estimated the impact of NHS Health Check on morbidity and mortality from cardiovascular disease, and compared that with other public health strategies. The authors found that universal screening was the least effective strategy in reducing health inequalities, whereas a combination of population-wide intervention and targeted screening (for the most deprived areas) was the most effective.…”

mentioning

confidence: 99%

The authors respond to “NHS Health Check: national evaluation findings and implications”

Chang

Majeed

Vámos

et al. 2017

CMAJ

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Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis

Cited by 60 publications

References 41 publications

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

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

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

The authors respond to “NHS Health Check: national evaluation findings and implications”

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