scholarly journals Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029420
Author(s):  
Oliver Kennedy ◽  
Fangzhong Su ◽  
Robert Pears ◽  
Emily Walmsley ◽  
Paul Roderick
Keyword(s):  
Risk Factors ◽  
Randomised Controlled Trial ◽  
Multivariate Analyses ◽  
Controlled Trial ◽  
Health Check ◽  
Cvd Risk ◽  
General Practices ◽  
Randomised Controlled ◽  
Nhs Health Check

ObjectiveTo evaluate uptake, risk factor detection and management from the National Health Service (NHS) Health Check (HC).DesignThis is a quasi-randomised controlled trial where participants were allocated to five cohorts based on birth year. Four cohorts were invited for an NHS HC between April 2011 and March 2015.Setting151 general practices in Hampshire, England, UK.Participants366 005 participants born 1 April 1940–31 March 1976 eligible for an NHS HC.InterventionNHS HC invitation.Main outcome measuresHC attendance and absolute percentage changes and ORs of (1) detecting cardiovascular disease (CVD) 10-year risk >10% and >20%, smokers, and total cholesterol (TC) >5.5 mmol/L and >7.5 mmol/L; (2) diagnosing hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD) and atrial fibrillation (AF); and (3) new interventions with statins, antihypertensives, antiglycaemics and nicotine replacement therapy (NRT).ResultsHC attendance rose from 12% to 30% between 2011/2012 and 2014/2015 (p<0.001). HC invitation increased detection of CVD risk >10% (2.0%–3.6, p<0.001) and >20% (0.1%–0.6%, p<0.001–0.392), TC >5.5 mmol/L (4.1%–7.0%, p<0.001) and >7.5 mmol/L (0.3%–0.4% p<0.001), hypertension (0.3%–0.6%, p<0.001–0.003), and interventions with statins (0.2%–0.9%, p<0.001–0.017) and antihypertensives (0.1%–0.6%, p<0.001–0.205). There were no consistent differences in detection of smokers, NRT, or diabetes, AF or CKD. Multivariate analyses showed associations between HC invitation and detecting CVD risk >10% (OR 8.01, 95% CI 7.34 to 8.73) and >20% (5.86, 4.83 to 7.10), TC >5.5 mmol/L (3.72, 3.57 to 3.89) and >7.5 mmol/L (2.89, 2.46 to 3.38), and diagnoses of hypertension (1.33, 1.20 to 1.47) and diabetes (1.34, 1.12 to 1.61). OR of CVD risk >10% plus statin and >20% plus statin, respectively, was 2.90 (2.36 to 3.57) and 2.60 (1.92 to 3.52), and for hypertension plus antihypertensive was 1.33 (1.18 to 1.50). There were no associations with AF, CKD, antiglycaemics or NRT. Detection of several risk factors varied inversely by deprivation.ConclusionsHC invitation increased detection of cardiovascular risk factors, but corresponding increases in evidence-based interventions were modest.

scholarly journals Effects of a 12-week cardiovascular rehabilitation programme on systemic inflammation and traditional coronary artery disease risk factors in patients with rheumatoid arthritis (CARDIA trial): a randomised controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018540
Author(s):  
Stefan Heinze-Milne ◽  
Volodko Bakowsky ◽  
Nicholas Giacomantonio ◽  
Scott A Grandy
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Heart Rate ◽  
Randomised Controlled Trial ◽  
Systemic Inflammation ◽  
Controlled Trial ◽  
Disease Assessment ◽  
Cvd Risk ◽  
Increased Risk ◽  
Randomised Controlled

IntroductionPatients with systemic inflammatory diseases such as rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) above the baseline risk attributable to traditional CVD risk factors seen in the general population. Exercise in cardiac rehabilitation (CR) is designed specifically for high-risk primary prevention and those with established CVD. Even though the European League Against Rheumatism guidelines state that exercise is safe for individuals with RA and exercise can reduce CVD risk, patients with RA rarely participate in CR. Thus, little is known about CR’s impact on inflammatory and CVD risk in the RA population. The purpose of this trial is to determine the feasibility of a 12-week CR programme for patients with RA and whether it decreases CVD risk without exacerbating RA.Methods and analysisThis is a randomised controlled trial whereby 60 participants with RA will be recruited and randomly assigned to either standard of care (SOC) treatment or SOC plus a 12-week CR programme (60 min of education plus two 60 min aerobic exercise sessions/week). Exercise will be performed at 60%–80% of heart rate reserve. Outcome measures (Framingham Risk Score, resting heart rate, blood pressure, blood lipids, markers of systemic inflammation (ie, interleukin (IL) 6 and tumour necrosis factor-α (TNF-α), Clinical Disease Assessment Index, Disease Activity Score-28, physical activity levels and peak cardiorespiratory fitness) will be assessed preintervention (week-0), postintervention (week-13) and 6 months postintervention.Ethics and disseminationEthical approval was obtained from the Nova Scotia Health Authority Research Ethics Board. Results will be submitted for publication in an appropriate peer-reviewed journal.Trial registration numberNCT01534871; Pre-results

scholarly journals Effectiveness of the population-based ‘check your health preventive programme’ conducted in a primary care setting: a pragmatic randomised controlled trial

2021 ◽  
pp. jech-2021-216581
Author(s):  
Anne-Louise Bjerregaard ◽  
Else-Marie Dalsgaard ◽  
Niels-Henrik Bruun ◽  
Kasper Norman ◽  
Daniel R Witte ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Randomised Controlled Trial ◽  
General Population ◽  
Sick Leave ◽  
Controlled Trial ◽  
Health Check ◽  
Cvd Risk ◽  
Health Checks ◽  
Wide Range ◽  
Randomised Controlled

BackgroundHealth checks have been suggested as an early detection approach aiming at lowering the risk of chronic disease development. This study aimed to evaluate the effectiveness of a health check programme offered to the general population, aged 30–49 years.MethodsThe entire population aged 30–49 years (N=26 216) living in the municipality of Randers, Denmark, was invited to a health check during 5 years. A pragmatic household cluster-randomised controlled trial was conducted in 10 505 citizens. The intervention group (IG, N=5250) included citizens randomised to the second year and reinvited in the 5th year. The comparison group (CG, N=5255) included citizens randomised to the 5th year. Outcomes were modelled cardiovascular disease (CVD) risk; self-reported physical activity (PA) and objectively measured cardio respiratory fitness (CRF); self-rated health (short-form 12 (SF-12)), self-rated mental health (SF-12_Mental Component Score (MCS)) and, registry information on sick-leave and employment. Due to low participation, we compared groups matched on propensity scores for participation when reinvited.ResultsParticipation in the first health check was 51% (N=2698) in the IG and 40% (N=2120) in the CG. In the IG 26% (N=1340) participated in both the first and second health checks. No intervention effects were found comparing IG and CG. Mean differences were (95% CI): modelled CVD risk: −0.052 (95% CI −0.107 to 0.003)%, PA: −0.156 (−0.331 to 0.019) days/week with 30 min moderate PA, CRF: 0.133 (−0.560 to 0.826) mL O2/min/kg, SF-12: −0.003 (−0.032 to 0.026), SF-12_MCS: 0.355 (-0.423 to 1.132), sick leave periods ≥3 weeks: −0.004 (−0.025 to 0.017), employment: −0.004 (−0.032 to 0.024).ConclusionsPreventive health checks offered to the general population, aged 30–49 years, had no effects on a wide range of indicators of chronic disease risk.Trial registration numberNCT02028195.

scholarly journals Swāsthya, an integrated chronic condition management programme for families of patients with hypertension and diabetes mellitus: a study protocol for a randomised controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M D Saju ◽  
Bindiya M Varghese ◽  
Lorane Scaria ◽  
Anuja Maria Benny ◽  
Shilpa V Yohannan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Randomised Controlled Trial ◽  
Social Cohesion ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Controlled Trial ◽  
Risk Groups ◽  
Care Model ◽  
Randomised Controlled

Abstract Background Kerala is known as the diabetes mellitus (DM) and hypertension (HTN) capital of the world, thus compelling health professionals to model strategies, addressing their social, behavioural, and cognitive risk factors and eliminating various barriers to management. This paper describes the protocol of our study that aims to examine the effectiveness and sustainability of an integrated care model for the management of chronic conditions and their risk factors through a family-based intervention. The proposed care model targets to modify systems and processes that predispose to chronic conditions by enhancing social cohesion and social networks, preventing lifestyle risks, developing iterative cognitive interventions, and engaging the family into customised treatment adherence strategies navigated by community health social workers (CHSWs). Methods A cluster randomised controlled trial (RCT) in selected participants will be conducted involving additional assessments prior to the baseline assessment. The assessment will identify and categorise patients into four risk groups, namely behavioural, social, cognitive, and multiple, based on dominant risks identified. Eligible participants will be randomly allocated (at a ratio of 1:1) into the intervention or control arm. The intervention arm will receive social, behavioural, and cognitive or multiple interventions corresponding to the identified risk groups, whereas the control arm will receive general intervention. Both the groups will be followed up at 6 months and 12 months post baseline to measure outcomes. The primary outcome will be the control of HTN and DM, and secondary outcomes include decreased depression and anxiety and improved functioning, social cohesion, and social network linkages. The sustainability and scalability of this intervention will be assessed through cost effectiveness, acceptability, and user friendliness of the integrated approach by performing a qualitative evaluation. Discussion This RCT will inform the potential paradigm shift from a medical model of chronic condition management to a multidimensional, multisystem, and multidisciplinary convergence model navigated by CHSWs. Such a model is not currently considered in the management of chronic conditions in Kerala. Trial registration Trial has been prospectively registered on Clinical Trial Registry of India- CTRI/2020/12/029474 on 1st December 2020.

Sign in / Sign up

Export Citation Format

Share Document