A quantitative service evaluation of a telephone outreach initiative to enhance the uptake of NHS Health Checks

A Quantitative Service Evaluation of a Telephone Outreach Initiative to Enhance theUptake of NHS Health Checks

Nikki Coghill, University of Bath

Problem
The NHS Health Check programme aims to identify cardiovascular (CV) risk in those aged 40-74, with
the goal of reducing cardiovascular events and health inequalities.CV incident is higher in lower
socioeconomic and ethnic minority groups. Invitations for a Checks are usually made via letter.
However, research has indicated that telephone and verbal invitations increase likelihood of
attendance. To address this and encourage the above groups to better engage with NHS Health
Checks we adopted a novel approach compared to the usual invite. Our aim was to determine the
efficacy of a targeted telephone outreach service for inviting patient from ‘hard to reach groups for an
NHS health Check, in general practices located in the most deprived areas of Bristol.
Approach
Using a quasi-experimental approach, 12 general-practices self-selected to use the telephone
outreach initiative (intervention). Specially trained, community-link workers contacted patients, and
conducted aspects of the Check by phone. Following this, patient’s were invited to complete
remaining aspects of their Check at their general-practice. Five practices acted as a control, using a
letter, opportunistic or telephone call invitations; with no aspect of the Check being conducted during
the telephone call. Primary outcome: 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
control Secondary outcomes: Investigate the relationship between attendance and patient
demographics (age, gender, IMD and ethnicity) in the target population. Descriptive statistics
characterised populations and binary logistical regression tested associations between attendance for
a health check and population characteristics.
Findings
Uptake was 24% and 35% in intervention versus control practices. Missing data precluded inclusion
of ethnicity in regression models. Intervention practices were more successful at attracting ethnic
minority patients to complete their Check (25.6%) compared to control practices (7.2%). In
intervention practices after controlling for age, gender, IMD quintile and telephone-call outcome, age
wasn’t a significant predictor of attendance; compared to women, men were significantly less likely to
complete their Check (OR 0.75 95% CI 0.58 to 0.98); IMD was a significant predicator of attendance
with those in the fifth IMD quintile being less likely to attend compared to those in the first IMD quintile
(OR 0.64 95% CI 0.50 to 0.82).
Consequences
Despite this initiative being offered by the most deprived practices in Bristol, it attracted the least
deprived patients. However, intervention practises were more successful at attracting patients from
ethnic minorities. We only evaluated the first nine months of the initiative. Previous novel initiatives
encouraging uptake of Health Checks, in Bristol, have shown a lagged adoption. Feedback on
improvements, based on recommendations from this evaluation, may result in enhanced uptake from
the intervention as it further embeds within practices