This research was designed and conducted to determine the efficacy of a telephone outreach service that was implemented to enhance the uptake of NHS Health Checks in GP practices located in some of the most deprived areas in Bristol.
Cardiovascular Disease (CVD) is one of the leading causes of premature mortality and morbidity in the UK with an estimated cost to the NHS of £14.4 billion. The incidence of CVD is projected to rise due to an ageing population and a high incidence of hypertension and Type 2 diabetes. Both of these conditions are associated with obesity, a condition which is reaching epidemic proportions, and is a modifiable risk factor for CVD.
The NHS Health Checks programme is a national programme introduced in 2009 as part of a government programme to reduce avoidable deaths and disability. The main aim of the NHS Health Check is to improve the health and wellbeing of adults aged 40-74 years. It aims to do this through the promotion of earlier awareness, assessment and management of major risk factors and conditions that contribute to premature death and disability. Additionally, it aspires to contributing towards reducing health inequalities in England. NHS Health Checks are mainly delivered in GP practices by nurses or healthcare assistants who usually invite patients by letter.
However, the method used to invite patients for an NHS Health Check has been shown to influence their likelihood of attendance. A recent study that explored attendance and method of invite for a Health Check found that verbal and telephone invitations resulted in a greater likelihood of attendance compared to a written letter invitation. This has recently been demonstrated by a GP practice in a deprived area of South Bristol. The practice piloted a telephone invitation method for engaging eligible patients for an NHS Health Check. Community link workers telephoned eligible patients, and if the patient consented, they completed selected aspects of the NHS Health Check by telephone. This was followed by inviting the patient to attend their GP practice for the remaining aspects of the NHS Health Check to be completed. This mainly included the physiological measurements for example blood tests and blood pressure. They found that their rate of ratio of invitations made to attendance for the full Health Check increased from 36%, using a traditional letter invite, to 78% using the telephone invitation method.
As a consequence of this success, Bristol City Council (Public Health) identified funding to enable this model to be rolled out to all GP practices within the lowest lower layer super output areas (LSOAs) throughout the City of Bristol.
We used a quantitative, quasi-experimental approach, to examine the relationship between attendance, or not for an NHS Health Check and age, gender, Index of Multiple Deprivation (IMD) score and ethnicity. We compared and contrasted the types of patients who attended for an NHS Health Check as a result of the telephone outreach initiative, with those who attended for an NHS Health Check as a result of the more traditional letter invite. We also compared and contrasted attendance for an NHS Health Check during the intervention period, with a similar period, prior to the intervention.
To try and contextualise our results we explored and described potential confounding influences that may have encouraged or discouraged uptake of an NHS Health Check over the intervention period.
The main aims and objectives of this work were:
•To evaluate the effectiveness of the telephone outreach service versus the standard invitation approach on uptake of NHS Health Checks in GP practices located in the lowest lower super output areas (LSOAs) in the city of Bristol.
•Using practices located in the lowest LSOAs in the City of Bristol, compare the rate of uptake of an NHS Health Check in the target population, in GP practices using the telephone outreach initiative, with the rate of uptake in comparison / control practices who were using the traditional letter invite.
•Investigate the relationship in the target population of those who attended or declined an NHS heath check, with age, gender, IMD and ethnicity, in both patients who were invited using the telephone outreach initiative and the traditional letter invite.
•To explore other possible influencing factors on the uptake of NHS Health Checks, by the target population, during the study period.
Intervention practices were more successful at attracting ethnic minority patients to complete their check (25.6%), compared to control practices (7.2%).
However, intervention practices showed a 24% rate of uptake compared to 36% in control practices.
Intervention patients were more likely to attend their GP practice to complete their Check, following their phone call if: female, aged over 70 or less deprived.
Only the first none-months of the initiative were evaluated. Previous initiatives to encourage uptake of health checks in Bristol, have shown a lag in adoption. Feedback on improvements, from this evaluation, may result in enhanced uptake as the intervention embeds within practices.