Perceptions of health professionals involved in a NHS Health Check care pathway

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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NHS Health Checks for people with mental ill-health 2013–2017: an observational study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001006 ◽

2020 ◽

Vol 29 ◽

Author(s):

C. Garriga ◽

J. Robson ◽

C. Coupland ◽

J. Hippisley-Cox

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Events ◽

Health Check ◽

Health Checks ◽

Hazard Ratios ◽

Nationally Representative ◽

Nhs Health Checks ◽

Nhs Health Check

Abstract Aims People living with serious mental ill-health experience adverse cardiovascular outcomes causing some of the greatest health inequality gaps in England, UK. We describe uptake of the NHS Health Check programme in people with mental ill-health, and rates of new diagnoses and management of cardiovascular risk factors in those who attend NHS Health Checks in comparison to those people without mental ill-health. Methods We used a large nationally representative database of people registered with general practitioners in England (QResearch). Between 2013 and 2017, we analysed attendance at NHS Health Checks and outcomes in the succeeding 12 months, in people with serious mental illness (SMI) including psychoses and in people prescribed long-term antidepressant medications (LTAD), with comparison to attendees who did not have these conditions. Hazard ratios (HR) were used to describe the association between outcomes and SMI and LTAD adjusting for sociodemographic variables. Results In those eligible for the NHS Health Check programme, we found a higher percentage of people with SMI attended an NHS Health Check (65 490, 19.8%) than those without SMI (524 728, 16.6%); adjusted HR 1.05 [95% confidence interval 1.02–1.08]. We also observed a higher percentage of attendance in people on LTAD (46 437, 20.1%) compared to people who were not prescribed LTAD (543 781, 16.7%); adjusted HR 1.10 (1.08–1.13). People with SMI were more likely to be identified with chronic kidney disease (CKD, HR 1.23, 1.12–1.34) and type 2 diabetes (HR 1.14, 1.03–1.25) within the 12 months following their NHS Health Check compared with those without SMI. People on LTAD were more likely to be identified with CKD (HR 1.55, 1.42–1.70) and type 2 diabetes (HR 1.45, 1.31–1.60) and also hypertension, cardiovascular disease, non-diabetic hyperglycaemia, familial hypercholesterolemia and dementia within the 12 months following their NHS Health Check. Statins were more likely to be prescribed to NHS Health Check attendees with SMI and those on LTAD than those without these conditions; HR 1.31 (1.25–1.38) and 1.91 (1.82–2.01), respectively. Antihypertensives were more likely to be prescribed to those on LTAD; HR 1.21 (1.14–1.29). Conclusions We found evidence that people with SMI or on LTAD treatment were 5–10% more likely to access NHS Health Checks than people without these conditions. People with SMI or on LTAD treatment who attended NHS Health Checks had higher rates of diagnosis of CKD, type 2 diabetes and some other relevant co-morbidities and increased treatment with statins and also anti-hypertensive medication in people on LTAD. This is likely to contribute to equitable reduction in adverse cardiovascular events for people with mental ill-health.

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Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

BMC Family Practice ◽

10.1186/s12875-021-01410-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Eva Seckler ◽

Verena Regauer ◽

Melanie Krüger ◽

Anna Gabriel ◽

Joachim Hermsdörfer ◽

...

Keyword(s):

Primary Care ◽

Data Collection ◽

Older People ◽

Process Evaluation ◽

Feasibility Study ◽

Health Professionals ◽

Implementation Strategy ◽

Care Pathway ◽

Main Trial ◽

Telephone Helpline

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

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Moving from Assessing Cardiovascular Risk to Altering Risk Trajectories: Opportunities Revealed by England’s NHS Health Check Programme

SSRN Electronic Journal ◽

10.2139/ssrn.3924714 ◽

2021 ◽

Author(s):

Riyaz Patel ◽

Sharmani Barnard ◽

Catherine Lagord ◽

Katherine Thompson ◽

Andrew Hughes ◽

...

Keyword(s):

Cardiovascular Risk ◽

Health Check ◽

Nhs Health Check

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Be SMART: examining the experience of implementing the NHS Health Check in UK primary care

BMC Family Practice ◽

10.1186/s12875-014-0212-7 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 19

Author(s):

Rachel L Shaw ◽

Helen M Pattison ◽

Carol Holland ◽

Richard Cooke

Keyword(s):

Primary Care ◽

Health Check ◽

Nhs Health Check

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Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis

British Journal of General Practice ◽

10.3399/bjgp17x693929 ◽

2017 ◽

Vol 68 (666) ◽

pp. e28-e35 ◽

Cited By ~ 16

Author(s):

Emma Harte ◽

Calum MacLure ◽

Adam Martin ◽

Catherine L Saunders ◽

Catherine Meads ◽

...

Keyword(s):

Systematic Review ◽

Health Management ◽

Health Check ◽

Cochrane Library ◽

Inclusion Criteria ◽

Qualitative Synthesis ◽

Health Checks ◽

The Impact ◽

Nhs Health Checks ◽

Nhs Health Check

BackgroundThe NHS Health Check programme is a prevention initiative offering cardiovascular risk assessment and management advice to adults aged 40–74 years across England. Its effectiveness depends on uptake. When it was introduced in 2009, it was anticipated that all those eligible would be invited over a 5-year cycle and 75% of those invited would attend. So far in the current cycle from 2013 to 2018, 33.8% of those eligible have attended, which is equal to 48.5% of those invited to attend. Understanding the reasons why some people do not attend is important to maximise the impact of the programmes.AimTo review why people do not attend NHS Health Checks.Design and settingA systematic review and thematic synthesis of qualitative studies.MethodAn electronic literature search was carried out of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index to Nursing and Allied Health Literature, Global Health, PsycINFO, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov, and the ISRCTN registry from 1 January 1996 to 9 November 2016, and the reference lists of all included papers were also screened manually. Inclusion criteria were primary research studies that reported the views of people who were eligible for but had not attended an NHS Health Check.ResultsNine studies met the inclusion criteria. Reasons for not attending included lack of awareness or knowledge, misunderstanding the purpose of the NHS Health Check, aversion to preventive medicine, time constraints, difficulties with access to general practices, and doubts regarding pharmacies as appropriate settings.ConclusionThe findings particularly highlight the need for improved communication and publicity around the purpose of the NHS Health Check programme and the personal health benefits of risk factor detection.

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Haemophilia in France: Modelisation of the Clinical Pathway for Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020646 ◽

2022 ◽

Vol 19 (2) ◽

pp. 646

Author(s):

Karen Beny ◽

Benjamin du Sartz de Vigneulles ◽

Florence Carrouel ◽

Denis Bourgeois ◽

Valérie Gay ◽

...

Keyword(s):

Health Care Providers ◽

Health Professionals ◽

Care Pathway ◽

Exploratory Research ◽

Care Providers ◽

Process Of Care ◽

Treatment Delivery ◽

Community Environment ◽

Specialized Service ◽

A Current

Process-of-care studies participate in improving the efficiency of the care pathway for patient with haemophilia (CPPH) and rationalize the multidisciplinary management of patients. Our objective is to establish a current overview of the different actors involved in the management of patients with haemophilia and to provide an accurate description of the patient trajectory. This is a qualitative exploratory research based on interviews of the principal health professionals of four haemophilia services, between November 2019 and February 2020, in France. Mapping of the CPPH processes within the different institutions and/or services, as well as the rupture zones, were identified. Treatment delivery and biological analyses were carried out exclusively in healthcare institutions. The main liberal health professionals solicited were nurses, physiotherapists and general practitioner. Obstacles and barriers within the specialized service, with other hospital services and external hospital or private services, community health care providers et community environment and individual one was complex and multiples. Our research identified potential concerns that need to be addressed to improve future studies to identify influential elements. Similarly, other qualitative studies will have to be conducted on the perceptions and literacy of patients with haemophilia to develop a global interactive mapping of their trajectories.

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