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

Abstract

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.

A systematic review of factors influencing NHS health check uptake: invitation methods, patient characteristics, and the impact of interventions

“…The nine included studies were conducted between 2011 and 2016, using data from 2008 to 2014. The sample sizes varied from 1380 patients [19] to 40,112 patients [20], and included between four [19,21] and 38 GP Practices [22]. The length of studies (including the follow up period) varied from 6 months [23] to 4 years [22].…”

Patient experiences of telephone outreach to enhance uptake of NHS Health Checks in more deprived communities and minority ethnic groups: A qualitative interview study

“…Our linked qualitative evaluation with staff delivering the telephone outreach intervention found that “matching” was important—to capitalize on outreach workers’ specialist skills and maximize the potential impact of the intervention. However, such matching could be difficult to achieve due to (a) ethnicity being poorly recorded in medical records, and (b) the support of participating primary care practices being required for outreach callers to be provided with appropriate lists of patients (T. J. Stone, E. Brangan, A. Chappell, V. Harrison, J. Horwood, unpublished data).…”

“…However, evidence on uptake in different ethnic groups was mixed, with conflicting findings . Analyses were limited by high levels of missing ethnicity data in primary care practice records, with uptake significantly lower for those with this data missing . Qualitative research with staff delivering health checks found perceptions that people from black and minority ethnic groups were less likely to attend, with language and cultural issues seen as major barriers …”

Prevalence of chronic kidney disease in the community using data from OxRen: a UK population-based cohort study

“…healthcheck.nhs.uk), which is a 5-yearly free check-up available for adults in the UK aged 40-74 years. However, only 43% of those invited for an NHS Health Check are reported to attend, 39 and it is likely that many non-attenders will be those most at risk. 40 OxRen provides an estimate of undiagnosed CKD in the UK population aged ≥60 years, including screen-detected rates, and will provide future estimates of incidence.…”