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Research

Fidelity of the delivery of NHS Health Checks in general practice: an observational study

Ben Paxton, Katie Mills and Juliet A Usher-Smith
BJGP Open 2020; 4 (4): bjgpopen20X101077. DOI: https://doi.org/10.3399/bjgpopen20X101077
Ben Paxton
1 University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Katie Mills
2 The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Juliet A Usher-Smith
2 The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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  • ORCID record for Juliet A Usher-Smith
  • For correspondence: jau20@medschl.cam.ac.uk
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Article Figures & Data

Tables

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    Table 1. NHS Health Check fidelity checklist based on NHS Health Check Best Practice Guidance1
    ItemCriteria
    Risk assessment
    EthnicityAsked patient their ethnicity
    HeightMeasured height
    WeightMeasured weight
    Blood pressureMeasured blood pressure
    Pulse rhythmPalpated pulse and verbalised comment regarding pulse
    CholesterolEvidence of cholesterol measurement taken
    Family history of CVDAsked patient about any family history of cardiovascular disease
    Alcohol usageAsked patient about alcohol consumption per week
    Smoking historyAsked patient about smoking status
    Weekly physical activityAsked patient number of hours of physical activity completed per week
    Risk communication
    QRISK2 scoreTold patient their QRISK2 percentage score
    Blood pressureTold patient their blood pressure
    BMITold patient their BMI
    CholesterolTold patient their cholesterol
    AUDIT-CTold patient their AUDIT-C score
    Risk management
    Lifestyle adviceSuggested, or encouraged the patient to suggest, specific lifestyle changes for risk reduction
    Clinically appropriate lifestyle adviceAs for 'lifestyle advice', but where lifestyle advice is given which relates to at least one lifestyle factor for which the patient was outside of the recommended limits
    Dementia risk informationTold patient the key message that the risk factors for CVD and dementia are the same
    • BMI = body mass index. CVD = cardiovascular disease.

    • View popup
    Table 2. Patient characteristics
    Characteristic n (%)a
    Mean a ge, years ( range, SD) 52.2(40 to 73, 9.3)
    Sex Female26 (68.4)
    Male12 (31.6)
    Ethnicity White34 (89.5)
    Mixed/multiple ethnic group0 (0.0)
    Asian/Asian British1 (2.6)
    Black/African/Caribbean/Black British3 (7.9)
    Family history of CVD in a first-degree relative 19 (50.0)
    BMI >25  26 (68.4)
    Weekly moderate physical exercise <2.5 hours  14 (36.8)
    Weekly alcohol consumption >14 units  7 (18.4)
    Current smoker 2 (5.3)
    QRISK2 >10%  7 (18.4)
    Education level  University18 (47.4)
    Secondary19 (50.0)
    Primary1 (2.6)
    Deprivation quintile b  14 (10.5)
    214 (36.8)
    311 (28.9)
    49 (23.7)
    50 (0.0)
    • aUnless otherwise stated. bIndex of Multiple Deprivation quintile: 1 = least deprived, 5 = most deprived. BMI = body mass index. CVD = cardiovascular disease. SD = standard deviation.

    • View popup
    Table 3. Overall fidelity assessment for each HCP
    HCPRoleConsultations, n Elements (N = 18)completed, mean (%)Elements (N = 18) completed, range (%)
    A HCA514.0 (77.8)11 to 16 (61.1 to 88.9)
    B Practice nurse214.5 (80.6)14 to 15 (77.8 to 83.3)
    C Practice nurse216.0 (88.9)15 to 17 (83.3 to 94.4)
    D HCA615.0 (83.3)15 to 15 (83.3 to 83.3)
    E HCA1814.1 (78.4)12 to 17 (66.7 to 94.4)
    F Practice nurse315.3 (85.2)14 to 16 (77.8 to 88.9)
    G HCA214.0 (77.8)14 to 14 (77.8 to 77.8)
    • HCA = healthcare assistant. HCP = healthcare professional.

    • View popup
    Table 4. Fidelity by NHS Health Check element
    Element of NHS Health CheckConsultationscompleted, n (%)
    Risk assessment Ethnicity12 (31.6)
    Height38 (100)
    Weight38 (100)
    Blood pressure38 (100)
    Pulse rhythm29 (76.3)
    Cholesterol36 (94.7)
    Family history of CVD25 (65.8)
    Alcohol consumption38 (100)
    Smoking38 (100)
    Physical activity38 (100)
    Risk communication QRISK237 (97.4)
    Blood pressure36 (94.7)
    BMI35 (92.1)
    Cholesterol34 (89.5)
    AUDIT-C13 (34.2)
    Risk management Lifestyle advice34 (89.5)
    Clinically appropriate lifestyle advice34 (89.5)
    Dementia6 (15.8)
    • BMI = body mass index. CVD = cardiovascular disease.

    • View popup
    Table 5. Clinically appropriate lifestyle advice
    Of participants with lifestyle factor outside recommended range, number receiving:
    Lifestyle Factor Participants outside of UK Chief Medical Officer’s recommended range, n (%) Risk assessment communicated, a n (%) Clinically appropriate lifestyle advice, n (%)
    Overweight26 (68.4)24 (92.3)22 (84.6)
    Exercise14 (36.8)No relevant risk score9 (64.3)
    Alcohol7 (18.4)5 (71.4)4 (57.1)
    Smoking2 (5.3)No relevant risk score2 (100)
    • BMI = body mass index.

    • ↵a Risk scores communicated: weight = BMI; alcohol consumption = AUDIT-C.

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Fidelity of the delivery of NHS Health Checks in general practice: an observational study
Ben Paxton, Katie Mills, Juliet A Usher-Smith
BJGP Open 2020; 4 (4): bjgpopen20X101077. DOI: 10.3399/bjgpopen20X101077

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Fidelity of the delivery of NHS Health Checks in general practice: an observational study
Ben Paxton, Katie Mills, Juliet A Usher-Smith
BJGP Open 2020; 4 (4): bjgpopen20X101077. DOI: 10.3399/bjgpopen20X101077
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Keywords

  • NHS Health Check
  • fidelity
  • Communication
  • risk assessment
  • general practice
  • health promotion
  • cardiovascular disease
  • dementia
  • Referral and consultation

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