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NHS Health Checks: the importance of targeted approaches for male and BAME patients to improve equity in uptake

11 April 2018

Patients are more likely to attend an NHS Health Check if they’re already at lower risk of stroke or heart attack, a University of Bristol evaluation has found. The patient groups most likely to respond to the standard invitation to attend a check are female, ‘white British’, older or from more affluent areas.

Researchers from NIHR CLAHRC West and the Centre for Academic Primary Care (CAPC) looked at routinely collected data from GP practices in Bristol between 2010 and 2014, assessing which patients followed up their invitation to attend an NHS Health Check. Over the data collection period, 31,881 invitations for an NHS Health Check were offered to eligible individuals and 13,733 checks were completed.

Slightly more women compared to men attended (53 per cent versus 47 per cent), and, from the target 40–74 age range, more patients aged over 60. People from the most deprived communities were less likely to attend than those from more affluent areas (39 per cent versus 47 per cent).

The proportion of black, Asian and minority ethnic (BAME) people attending NHS Health Checks was lower than in Bristol’s overall population. BAME groups make up 16 per cent of the population of Bristol. But more non-black and Asian patients were invited (64 per cent versus 9 per cent) and most attendees were also from non-black and Asian groups (85 per cent versus 10 per cent). However, ethnicity was poorly recorded by GP practices, particularly for those patients who didn’t attend an NHS Health Check.

Sixty-two per cent of those invited and who completed their check had a low risk of having a heart attack or stroke, compared to those with a medium (26 per cent) or high risk (12.5 per cent). People with a high risk of heart attack or stroke were more likely to be prescribed a cardiovascular drug and referred to a behavioural lifestyle service such as smoking cessation, exercise or weight management. Patients referred to behavioural lifestyle management were more likely to be living in the most deprived areas.

Dr Jeremy Horwood, a researcher at Centre for Academic Primary Care and NIHR CLAHRC West and co-author of the study, said:“Our findings highlight the importance of targeted approaches for the patient groups most likely to benefit from NHS Health Checks. Improving uptake in these key groups would really increase the impact of the programme in reducing health inequalities.”

Cardiovascular disease, including heart attacks and strokes, is a major cause of early death, ill-health and disability in the UK. People living in deprived circumstances or from BAME communities are more likely to experience cardiovascular disease.

NHS Health Checks were introduced in England in 2009 as part of a government commitment to tackle avoidable deaths, disability and reduce health inequalities. The programme offers people aged between 40 and 74, without pre-existing cardiovascular disease, kidney disease, type 2 diabetes, or dementia, an assessment of their risk of developing these conditions, and access to lifestyle and health advice.

The research was funded by the National Institute for Health Research (NIHR) School for Primary Care Research.


NHS health checks: a cross- sectional observational study on equity of uptake and outcomes
Coghill N, Garside L, Montgomery AA, Feder G, Horwood J
Published in BMC Health Services Research
2018 Apr 3;18(1):238. doi: 10.1186/s12913-018-3027-8.

More on NHS Health Checks

See our other NHS Health Checks project: Evaluating telephone outreach for NHS Health Checks to improve uptake in more deprived communities

Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.

About the NIHR:

The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health and Social Care, the NIHR:

· funds high quality research to improve health

· trains and supports health researchers

· provides world-class research facilities

· works with the life sciences industry and charities to benefit all

· involves patients and the public at every step

For further information, visit the NIHR website

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