scholarly journals A qualitative exploration of two risk calculators using video-recorded NHS health check consultations

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Victoria Riley ◽  
Naomi J. Ellis ◽  
Lisa Cowap ◽  
Sarah Grogan ◽  
Elizabeth Cottrell ◽  
...  
Keyword(s):  
Risk Communication ◽  
Health Check ◽  
Risk Calculator ◽  
Cvd Risk ◽  
Missed Opportunities ◽  
Coping Responses ◽  
Practitioner Training ◽  
The Uk ◽  
And Coping ◽  
Nhs Health Check

Abstract Background The aim of the study was to explore practitioner-patient interactions and patient responses when using QRISK®2 or JBS3 cardiovascular disease (CVD) risk calculators. Data were from video-recorded NHS Health Check (NHSHC) consultations captured as part of the UK RIsk COmmunication (RICO) study; a qualitative study of video-recorded NHSHC consultations from 12 general practices in the West Midlands, UK. Participants were those eligible for NHSHC based on national criteria (40–74 years old, no existing diagnoses for cardiovascular-related conditions, not on statins), and practitioners, who delivered the NHSHC. Method NHSHCs were video-recorded. One hundred twenty-eight consultations were transcribed and analysed using deductive thematic analysis and coded using a template based around Protection Motivation Theory. Results Key themes used to frame the analysis were Cognitive Appraisal (Threat Appraisal, and Coping Appraisal), and Coping Modes (Adaptive, and Maladaptive). Analysis showed little evidence of CVD risk communication, particularly in consultations using QRISK®2. Practitioners often missed opportunities to check patient understanding and encourage risk- reducing behaviour, regardless of the risk calculator used resulting in practitioner verbal dominance. JBS3 appeared to better promote opportunities to initiate risk-factor discussion, and Heart Age and visual representation of risk were more easily understood and impactful than 10-year percentage risk. However, a lack of effective CVD risk discussion in both risk calculator groups increased the likelihood of a maladaptive coping response. Conclusions The analysis demonstrates the importance of effective, shared practitioner-patient discussion to enable adaptive coping responses to CVD risk information, and highlights a need for effective and evidence-based practitioner training. Trial registration ISRCTN ISRCTN10443908. Registered 7th February 2017.

scholarly journals Cardiovascular disease risk communication in NHS health checks: video-stimulated recall interviews with practitioners

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0049
Author(s):  
Christopher J. Gidlow ◽  
Naomi Jane Ellis ◽  
Victoria Riley ◽  
Lisa Cowap ◽  
Diane Crone ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Communication ◽  
Disease Risk ◽  
Health Check ◽  
Risk Calculator ◽  
Cvd Risk ◽  
Stimulated Recall ◽  
Practitioner Training ◽  
Nhs Health Check ◽  
Heart Age

BackgroundNHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10 year/centage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk.AimTo explore practitioner understanding, perceptions and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators.Design & settingQualitative video-stimulated recall (VSR) study with NHSHC practitioners.MethodVSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n=7) or JBS3 lifetime CVD risk calculator (n=8). Data were analysed using reflexive thematic analysis.ResultsFindings from analysis of VSR interviews with 15 practitioners (9 Healthcare Assistants, 6 General Practice Nurses) are presented by risk calculator. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low/medium/high risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS functions were evident, particularly heart age, risk manipulation and visual presentation of risk.ConclusionsThere is a gap between the expectation and reality of practitioners’ understanding, competencies and training in CVD risk communication for NHS Health Check. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.

scholarly journals NHS Health Checks: Equity and outcomes 2009-17: An observational study

2021 ◽  
pp. BJGP.2020.1021
Author(s):  
John Robson ◽  
Cesar Garriga ◽  
Carol Coupland ◽  
Julia Hippisley-Cox
Keyword(s):  
Type 2 Diabetes ◽  
Ethnic Groups ◽  
South Asian ◽  
Cardiovascular Prevention ◽  
Health Check ◽  
Cvd Risk ◽  
Health Checks ◽  
Nhs Health Checks ◽  
Nhs Health Check

Background: The NHS Health Check cardiovascular prevention programme is now 10 years old. Aim: We describe NHS Heath Check attendance, new diagnoses and treatment in relation to equity indicators. Design and Setting: Using a national general practice database 2009-17, we compared NHS Health Check attendance and new diagnoses and treatments, by age, gender, ethnic group and deprivation. Results: In 2013-17, 590,218 eligible people age 40-74 years attended an NHS Health Check (16.9%) and 2,902,598 (83.1%) did not attend. South Asian ethnic groups were most likely to attend and women more than men. New diagnoses were more likely in attendees than non-attendees; hypertension 25/1000 attendees vs 9/1000 in non-attendees; type 2 diabetes 8/1000 vs 3/1000; chronic kidney disease 7/1000 vs 4/1000. In people aged 65 or older, new atrial fibrillation was diagnosed in 5/1000 attendees and 3/1000 non-attendees and for dementia 2/1000 versus 1/1000 respectively. Type 2 diabetes, hypertension and CKD were more likely in more deprived groups, South Asian and black African/Caribbean ethnic groups. Attendees were more likely to be prescribed statins, 26/1000, than non-attendees 8/1000; and anti-hypertensive medicines, 25/1000 vs 13/1000 non-attendees. However, of the 117,963 people with 10% or greater CVD risk eligible for statins only 9,785 (8.3%) were prescribed them. Conclusions: NHS Health Checks uptake remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension and CKD and receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, fewer than 10% were treated.

scholarly journals NHS Health Check programme: a protocol for a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e048937
Author(s):  
Claire Duddy ◽  
Geoff Wong ◽  
E W Gadsby ◽  
Janet Krska ◽  
Vivienne Hibberd
Keyword(s):  
Public Health ◽  
Adult Population ◽  
Realist Review ◽  
Health Check ◽  
Design Strategies ◽  
Cvd Risk ◽  
Increased Risk ◽  
Ethical Approval ◽  
Registration Number ◽  
Nhs Health Check

IntroductionThe NHS Health Check aims to identify individuals at increased risk of cardiovascular diseases (CVDs) among the adult population in England. The Health Check includes calculation of CVD risk and discussion of pharmacological and lifestyle approaches to manage risk, including referral to lifestyle support services. The programme is commissioned by Local Authorities (LAs) and is delivered by a range of different providers in different settings. There is significant variation in activity, with uptake ranging from 25% to 85% in different areas, and clear evidence of variation in implementation and delivery practice.Methods and analysisWe aim to understand how the NHS Health Check programme works in different settings, for different groups, so that we can recommend improvements to maximise intended outcomes. To do so, we will undertake a realist review and a survey of LA public health teams. Our review will follow Pawson’s five iterative stages: (1) locate existing theories, (2) search for evidence, (3) article selection, (4) extract and organise data and (5) synthesise evidence and draw conclusions. Our review will include documents describing local implementation alongside published research studies. We will recruit a stakeholder group (including Public Health England, commissioners and providers of Health Checks, plus members of the public and patients) to advise us throughout. Our survey will be sent to all 152 LAs in England to gather detailed information on programme delivery (including COVID-19-related changes) and available referral services. This will enable us to map delivery across England and relate these data to programme outcomes.Ethics and disseminationEthical approval is not required for this review. For the survey, we have received approval from the University of Kent Research Ethics Committee. Our findings will be used to develop recommendations on tailoring, implementation and design strategies to improve delivery of the NHS Health Check in different settings, for different groups.PROSPERO registration numberCRD42020163822.

scholarly journals Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e014413 ◽  
Author(s):  
Maria Woringer ◽  
Jessica Jones Nielsen ◽  
Lara Zibarras ◽  
Julie Evason ◽  
Angelos P Kassianos ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health Service ◽  
Healthy Eating ◽  
Perceived Risk ◽  
Health Check ◽  
Risk Awareness ◽  
Cvd Risk ◽  
Item Questionnaire ◽  
Intention To Change ◽  
Nhs Health Check

BackgroundThe National Health Service (NHS) Health Check is a cardiovascular disease (CVD) risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There is no tool to assess the effectiveness of the programme in communicating CVD risk to patients.AimsThe aim of this paper was to develop a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme.MethodsWe developed an 85-item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were added. The resulting 65-item questionnaire with satisfactory content validity (content validity indices≥0.80) and face validity was tested on 110 NHS Health Check attendees in primary care in a cross-sectional study between 21 May 2014 and 28 July 2014.ResultsFollowing analyses of data, we reduced the questionnaire from 65 to 26 items. The 26-item questionnaire constitutes four scales: Knowledge of CVD Risk and Prevention, Perceived Risk of Heart Attack/Stroke, Perceived Benefits and Intention to Change Behaviour and Healthy Eating Intentions. Perceived Risk (Cronbach’s α=0.85) and Perceived Benefits and Intention to Change Behaviour (Cronbach’s α=0.82) have satisfactory reliability (Cronbach’s α≥0.70). Healthy Eating Intentions (Cronbach’s α=0.56) is below minimum threshold for reliability but acceptable for a three-item scale.ConclusionsThe resulting questionnaire, with satisfactory reliability and validity, may be used in assessing patients’ awareness of CVD risk among NHS Health Check attendees.

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 Improving cardiovascular disease risk communication in NHS Health Checks: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e026058 ◽  
Author(s):  
Meredith K D Hawking ◽  
Adam Timmis ◽  
Fae Wilkins ◽  
Jessica L Potter ◽  
John Robson
Keyword(s):  
Cardiovascular Risk ◽  
Qualitative Study ◽  
Risk Communication ◽  
Risk Reduction ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Health Check ◽  
Health Checks ◽  
Nhs Health Checks ◽  
Nhs Health Check

ObjectiveThe NHS Health Check programme is a public screening and prevention initiative in England to detect early signs of cardiovascular ill health among healthy adults. We aimed to explore patient perspectives and experiences of a personalised Risk Report designed to improve cardiovascular risk communication in the NHS Health Check.Design and settingThis is a qualitative study with NHS Health Check attendees in three general practices in the London Borough of Newham.Intervention and participantsA personalised Risk Report for the NHS Health Check was developed to improve communication of results and advice. The Risk Report was embedded in the electronic health record, printed with auto-filled results and used as a discussion aid during the NHS Health Check, and was a take-home record of information and advice on risk reduction for the attendees. 18 purposively sampled socially diverse participants took part in semistructured interviews, which were analysed thematically.ResultsFor most participants, the NHS Health Check was an opportunity for reassurance and assessment, and the Risk Report was an enduring record that supported risk understanding, with impact beyond the individual. For a minority, ambivalence towards the Risk Report occurred in the context of attending for other reasons, and risk and lifestyle advice were not internalised or acted on.ConclusionOur findings demonstrate the potential of a personalised Risk Report as a useful intervention in NHS Health Checks for enhancing patient understanding of cardiovascular risk and strategies for risk reduction. Also highlighted are the challenges that must be overcome to ensure transferability of these benefits to diverse patient groups.Trial registration numberNCT02486913.

Implementation of NHS Health Checks in general practice: variation in delivery between practices and practitioners

2015 ◽  
Vol 17 (04) ◽  
pp. 385-392 ◽  
Author(s):  
Janet Krska ◽  
Ruth du Plessis ◽  
Hannah Chellaswamy
Keyword(s):  
Health Professionals ◽  
Significant Variation ◽  
Health Check ◽  
Risk Scores ◽  
Similar Proportion ◽  
Risk Category ◽  
Cvd Risk ◽  
Health Checks ◽  
Nhs Health Checks ◽  
Nhs Health Check

AimTo evaluate NHS Health Check implementation in terms of frequency of data recording, advice provided, referrals to community-based lifestyle support services, statin prescribing and new diagnoses, and to assess variation in these aspects between practices and health professionals involved in delivery.BackgroundMost NHS Health Checks are delivered by general practices, but little detail is known about the extent of variation in how they are delivered in different practices and by different health professionals.MethodsThis was an observational study conducted in a purposively selected sample of 13 practices in Sefton, North West England. Practices used previously recorded information from their clinical management systems to identify patients with cardiovascular disease (CVD) risk ⩾20%, a potentially cost-effective approach. The evaluation was conducted during the first year of delivery in Sefton. Data were extracted from medical records of all patients identified, regardless of Health Check attendance.FindingsOf the 2892 patients identified by the 13 practices, 1070 had received an NHS Health Check at the time of the study. Of these, only 936 (87.5%) had a recorded CVD risk score, with risk ⩾20% confirmed in 92.0%. Estimated risk category was correct in 456/677 (67.4%) of patients with estimated and actual risk scores.Significant variation was found between practices and health professionals in parameters recorded, tests requested, advice given and referrals for lifestyle support. Only 45.3% of patients had body mass index, smoking, alcohol, exercise, blood pressure and cholesterol all recorded.Lifestyle advice and referral into lifestyle services were documented in 80.6% and 6.4% of attenders, respectively, again with significant variation between practices and professionals. Statin prescribing rose in attenders from 19.6% to 34.6%. A similar proportion of attenders and non-attenders received new diagnoses.ConclusionEffort is required to reduce variation in how practices deliver and follow-up NHS Health Checks, to ensure the consistency of the programme.

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