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

Article Figures & Data

Table 1. NHS Health Check fidelity checklist based on NHS Health Check Best Practice Guidance¹

Item	Criteria
Risk assessment
Ethnicity	Asked patient their ethnicity
Height	Measured height
Weight	Measured weight
Blood pressure	Measured blood pressure
Pulse rhythm	Palpated pulse and verbalised comment regarding pulse
Cholesterol	Evidence of cholesterol measurement taken
Family history of CVD	Asked patient about any family history of cardiovascular disease
Alcohol usage	Asked patient about alcohol consumption per week
Smoking history	Asked patient about smoking status
Weekly physical activity	Asked patient number of hours of physical activity completed per week
Risk communication
QRISK2 score	Told patient their QRISK2 percentage score
Blood pressure	Told patient their blood pressure
BMI	Told patient their BMI
Cholesterol	Told patient their cholesterol
AUDIT-C	Told patient their AUDIT-C score
Risk management
Lifestyle advice	Suggested, or encouraged the patient to suggest, specific lifestyle changes for risk reduction
Clinically appropriate lifestyle advice	As 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 information	Told patient the key message that the risk factors for CVD and dementia are the same

Table 2. Patient characteristics

Characteristic		n (%)^a
Mean a ge, years ( range, SD)		52.2(40 to 73, 9.3)
Sex	Female	26 (68.4)
Sex	Male	12 (31.6)
Ethnicity	White	34 (89.5)
	Mixed/multiple ethnic group	0 (0.0)
	Asian/Asian British	1 (2.6)
	Black/African/Caribbean/Black British	3 (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	University	18 (47.4)
	Secondary	19 (50.0)
	Primary	1 (2.6)
Deprivation quintile ^b	1	4 (10.5)
	2	14 (36.8)
	3	11 (28.9)
	4	9 (23.7)
	5	0 (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.

Table 3. Overall fidelity assessment for each HCP

HCP	Role	Consultations, n	Elements (N = 18)completed, mean (%)	Elements (N = 18) completed, range (%)
A	HCA	5	14.0 (77.8)	11 to 16 (61.1 to 88.9)
B	Practice nurse	2	14.5 (80.6)	14 to 15 (77.8 to 83.3)
C	Practice nurse	2	16.0 (88.9)	15 to 17 (83.3 to 94.4)
D	HCA	6	15.0 (83.3)	15 to 15 (83.3 to 83.3)
E	HCA	18	14.1 (78.4)	12 to 17 (66.7 to 94.4)
F	Practice nurse	3	15.3 (85.2)	14 to 16 (77.8 to 88.9)
G	HCA	2	14.0 (77.8)	14 to 14 (77.8 to 77.8)

Table 4. Fidelity by NHS Health Check element

	Element of NHS Health Check	Consultationscompleted, n (%)
Risk assessment	Ethnicity	12 (31.6)
	Height	38 (100)
	Weight	38 (100)
	Blood pressure	38 (100)
	Pulse rhythm	29 (76.3)
	Cholesterol	36 (94.7)
	Family history of CVD	25 (65.8)
	Alcohol consumption	38 (100)
	Smoking	38 (100)
	Physical activity	38 (100)
Risk communication	QRISK2	37 (97.4)
	Blood pressure	36 (94.7)
	BMI	35 (92.1)
	Cholesterol	34 (89.5)
	AUDIT-C	13 (34.2)
Risk management	Lifestyle advice	34 (89.5)
	Clinically appropriate lifestyle advice	34 (89.5)
	Dementia	6 (15.8)

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 (%)
Overweight	26 (68.4)	24 (92.3)	22 (84.6)
Exercise	14 (36.8)	No relevant risk score	9 (64.3)
Alcohol	7 (18.4)	5 (71.4)	4 (57.1)
Smoking	2 (5.3)	No relevant risk score	2 (100)