Abstract
BackgroundNHS Health Check is a primary prevention programme offering cardiovascular disease (CVD) risk assessment to adults in England aged 40–74. Uptake remains a challenge and invitation method is a strong predictor of uptake. There is evidence of low uptake when using invitation letters. Telephone invitations might increase uptake, but are not widely used. We explored the potential to improve uptake through personalising letters to patient’s CVD risk, and to compare this with generic letters and telephone invitations.MethodsHEalth Check TRial (HECTR) was a three-arm randomised controlled trial in nine general practices in Staffordshire (UK). Eligible patients were randomised to be invited to a NHS Health Check using one of three methods: standard letter (control); telephone invitation; letter personalised to the patient’s CVD risk. The primary outcome was attendance/non-attendance. Data were collected on a range of patient- and practice-level factors (e.g., patient socio-demographics, CVD risk, practice size, Health Checks outside usual working hours). Multi-level logistic regression estimated the marginal effects to explore whether invitation method predicted attendance. Invitation costs were collated from practices to estimate cost benefit.ResultsIn total, 4614 patients were included in analysis (mean age 50.2 ± 8.0 yr.; 52.4% female). Compared with patients invited by standard letter (30.9%), uptake was significantly higher in those invited by telephone (47.6%, P < .001), but not personalised letter (31.3%, p = .812). In multi-level analysis, compared with the standard letter arm, likelihood of attendance was 18 percentage points higher in the telephone arm and 4 percentage points higher in the personalised letter arm. The effect of telephone calls appeared strongest in patients who were younger and had lower CVD risk. We estimated per 1000 patients invited, risk-personalised letters could result in 40 additional attended Health Checks (at no extra cost) and telephone invitations could result in 180 additional Health Checks at an additional cost of £240.ConclusionsTelephone invitations should be advocated to address the substantial deficit between current and required levels of NHS uptake, and could be targeted at younger and lower CVD risk adults. Risk-personalised letters should be explored further in a larger sample of high risk individuals.Trial registrationRegistration number: ISRCTN15840751 date of registration: 24/10/2017.
Highlights
NHS Health Check is a primary prevention programme offering cardiovascular disease (CVD) risk assessment to adults in England aged 40–74
This study focused on uptake, which is fundamental to the success of such population-based risk identification and management programmes [4, 5], and remains a challenge in NHS Health Check
We report findings from HEalth Check TRial (HECTR), a randomised controlled trial (RCT) to test whether invitation letters personalised to patient’s CVD risk could elicit higher uptake than the current national template letter, and to compare with uptake in response to telephone invitations
Summary
NHS Health Check is a primary prevention programme offering cardiovascular disease (CVD) risk assessment to adults in England aged 40–74. NHS Health Check is a national CVD risk assessment programme for adults in England aged 40–74 who do not have existing CVD-related conditions (e.g., diabetes, kidney disease) [2]. This study focused on uptake, which is fundamental to the success of such population-based risk identification and management programmes [4, 5], and remains a challenge in NHS Health Check. One of the reviewed studies involved interviews with 41 non-attenders to Health Checks and revealed that approximately one-third of participants did not recall receiving their invitation letter, with others reporting that it lacked relevant information or was not prioritised [16]
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