Abstract
BackgroundThe NHS Health Check programme aims to reduce the risk of common preventable diseases by providing risk information and behaviour change advice. Failure to deliver the consultation appropriately could undermine its efficacy. To date, to the authors’ knowledge, there are no published data on the fidelity of delivery of NHS Health Checks.AimTo assess the fidelity of delivery of NHS Health Checks in general practice.Design & settingFidelity assessment of video and audio recordings of NHS Health Check consultations conducted in four GP practices across the East of England.MethodA secondary analysis of 38 NHS Health Check consultations, which were video or audio recorded as part of a pilot study of introducing discussions of cancer risk into NHS Health Checks. Using a checklist based on the NHS Health Check Best Practice Guidance, fidelity of delivery was assessed as the proportion of key elements completed during the consultations.ResultsThe mean number of elements of the NHS Health Check completed across all consultations was 14.5/18 (80.6%), with a range of 10 to 17 (55.6% to 94.4%). The mean fidelity for risk assessment, risk communication, and risk management sections was 8.7/10 (87.0%), 4.1/5 (82.0%), and 1.7/3 (56.7%), respectively. Clinically appropriate lifestyle advice was given in 34/38 consultations. Elements with the lowest fidelity were ethnicity assessment (n = 12/38; 31.6%), family history of cardiovascular disease (CVD) assessment (n = 25/38; 65.8%), AUDIT-C communication (n = 13/38; 34.2%), and dementia risk management (n = 6/38; 15.8%).ConclusionAlthough fidelity of delivery was high overall, important elements of the NHS Health Check were being regularly omitted. Opportunities for behaviour change, particularly relating to alcohol consumption and dementia risk management, may be being missed.
Highlights
The NHS Health Check programme was introduced in England in 2009 as a primary prevention initiative that aims to prevent cardiovascular disease (CVD) through provision of risk information and behaviour change advice.[1]
The QRISK2 score should be communicated alongside body mass index (BMI), blood pressure, cholesterol, and the AUDIT-C score that describes levels of alcohol consumption.[3]
These results should form the basis of a discussion about risk management, encompassing lifestyle advice in line with recommendations from the UK Chief Medical Office, and medical management options, including prescription of statins and antihypertensive medication
Summary
The NHS Health Check programme was introduced in England in 2009 as a primary prevention initiative that aims to prevent CVD through provision of risk information and behaviour change advice.[1]. The consultation encompasses a risk assessment for CVD, alongside diabetes, hypertension, and chronic kidney disease (CKD). The risk of developing CVD in the 10 years should be assessed using the QRISK2 tool.[2] The QRISK2 score should be communicated alongside body mass index (BMI), blood pressure, cholesterol, and the AUDIT-C score that describes levels of alcohol consumption.[3] These results should form the basis of a discussion about risk management, encompassing lifestyle advice in line with recommendations from the UK Chief Medical Office (to maintain a BMI between 18.5 and 24.9 kg/m2, an alcohol consumption rate of ≤14 units/week,[4] do >150 minutes of moderate intensity exercise/week,[5] and to not smoke), and medical management options, including prescription of statins and antihypertensive medication. The NHS Health Check programme aims to reduce the risk of common preventable diseases by providing risk information and behaviour change advice. To the authors’ knowledge, there are no published data on the fidelity of delivery of NHS Health Checks
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