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Theme: Diagnostics & Stratified Medicine
Much premature disease and disability remain potentially avoidable in older populations, especially in the less privileged. Currently 36% of 65-74 year olds are obese, 50% do low levels of physical activity, 12% smoke and 23% are hypertensive but untreated. A prevention paradox is that numbers needed to treat are far lower in older groups (due to high baseline risks) e.g. to prevent 1 death over 5 years would require antihypertensive treatment for 1157 healthy young women but only 17 older men with other cardiovascular risk factors. Access to, and concordance with, risk reduction may alter in later life due to changing social context, increasing co-morbidity and fatalistic attitudes. The US Preventive Services Task Force recently formed a workgroup on older people, and noted the paucity of relevant evidence, such as attitudes to prevention in later life.
The NHS Health Check (NHSHC) for adults (40-74 years) aims to reduce cardiovascular disease (CVD) mortality and morbidity and tackle health inequalities. With national implementation required by 2012/13, the NHSHC is a national performance measure in the Operating Framework for the NHS. Recognising its importance, a performance indicator regarding the proportion of the eligible population invited for assessment will be monitored as part of the new Public Health Outcomes framework from April 2013. Asymptomatic individuals will be offered risk assessment once every five years (20% called per annum), with high risk (>20%) individuals offered clinical management (e.g. prescribing and lifestyle interventions, entry onto disease registers). Symptomatic individuals identified through general practice disease registers will not be offered screening as it is assumed that such individuals are already being managed as appropriate.
High uptake is critical to the programme’s success. Economic modelling of the NHSHC programme is based on an assumption that 75% of people invited to a health check will attend, and that there will be high uptake/compliance with management options, such as prescribing (e.g. statins 85% uptake/70% compliance) and lifestyle interventions (e.g. weight management 85% uptake/68% compliance). However, preliminary evidence from a deprived area of London offering a NHSHC to high risk patients reported 45% uptake, with certain groups (current smokers) less likely to attend. Similar data from Birmingham offering checks to all men aged over 40 years reported even lower uptake (24%).
To improve the uptake of NHS cardiovascular health checks in primary care by identifying factors that influence older people’s willingness to engage with primary preventative health care programmes.
There were two key parts to this research:
Stage 1. To map the methods that practices within the Torbay region are routinely using to invite eligible people for an NHSHC and to quantitatively explore the influence of these different models on health check uptake.
Stage 2. To qualitatively explore eligible patients’ choices around their (i) willingness to attend for an NHSHC at their local practice, and (ii) for those who completed an NHSHC, their views and experiences of undergoing the cardiovascular risk assessment and their future willingness to engage with the programme.
NHS ethical review and governace checks completed (October 2012)
Stage 1. fieldwork commenced November 2012 and study completion anticipated in March 2013.
Stage 2. fieldwork scheduled for March 2013 to July 2013
Dr Suzanne Richards, Professor John Campbell, Dr Kerry Jones, Dr Iain Lang, Dr Andy Gibson (PPI Involvement)