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- Delivery and impact of the NHS Health Check in the first 8 years: a systematic reviewWith reference to the systematic review by Martin et al,1 we report our own experience over two years of NHS Health Checks in one practice. We invited 636 patients (35% of eligible list) and 340 attended (53% uptake (95% CI 50 to 57)).2 We too found attenders to be older (mean 3 years) than non-attenders, more likely to be female, and have higher HDL cholesterol levels and lower total cholesterol: HDL ratios. Non-attenders had twice the smoking rate of attenders (18% vs. 9%).We followed up 94/340 (28%) of attendees for findings outside of target, most commonly blood pressure (BP) >140/90 (79; 23%). Ultimately, new diagnoses of hypertension were made for 14 (4%) attenders, diabetes mellitus for 7 (2%) and chronic kidney disease (CKD) stage 3 for 5 (1%). This low yield has previously been reported,3 and questions the cost effectiveness of this intervention.4Regarding the 79 people followed-up for a BP >140/90, 76 (96%) already had a BP entry in their records (pre-dating the Health Check) above 140/90 but without a diagnosis of hypertension. We estimated costs per Health Check using published data,5 and derived costs per new diagnosis of hypertension. Within the Health Check Programme these were £1083.73 (95% CI £686.57 to £2132.63). An alternative targeted approach to BP checks, inviting attendance based on existing records of eleva...Show MoreCompeting Interests: None declared.
- Delivery and impact of the NHS Health Check
Martin and colleagues must be congratulated for their hard work in seeking to assess the delivery and impact of the NHS Health Check programme.1 However, although they have identified some positive outcomes from the programme these are, at best, marginal.
But I would not to wish to see the initiative dropped as, unlike the various national NHS Screening Programmes, it promotes a much more patient-centred and risk-oriented approach. Coverage is also higher among older people and those living in the most deprived areas. What is needed now is a careful re-assessment of the programme in order to seek to deliver better value.
Based on my own review2 I would argue that the current exclusions are too broad and the scope is too narrow. For example, individuals on treatments for high blood pressure or elevated cholesterol should also be checked. Moreover, bowel cancer screening (using FIT) or diabetes risk assessment (using HbA1c) are additional areas to consider alongside the current cardiovascular focus.
References
1. Martin A, Saunders CL, Harte E, et al. Delivery and impact of the NHS Health Check in the first 8 years: a systematic review. Br J Gen Pract 2018; DOI: https://doi.org/10.3399/bjgp18X697649.
2. Summerton N. Better value health checks: a practical guide. London: CRC Press, 2018.
Competing Interests: None declared.