This project investigates the implementation, uptake and effectiveness of the NHS Health Check programme across GPs and pharmacies in Coventry and Warwickshire.
The Health Check programme is a national programme of primary prevention launched in 2009 by the Department of Health. The programme, now a mandatory Local Health service, targets people aged 40-74 without a previous cardiovascular diagnosis, and assesses the top seven causes of preventable deaths, i.e. high blood pressure, smoking, high cholesterol, obesity, poor diet, physical inactivity and alcohol consumption. Through the early identification and management of these risk factors, the programme aims to prevent diabetes, chronic kidney disease, dementia and cardiovascular disease and thus reduce morbidity, mortality and health inequalities.
Currently, evidence on the effectiveness is still limited (one RCT and six cross-sectional or cohort studies) and provides contradictory results on increases in the detection of risk factors, in the prescription of statins and in the reduction of patients’ risk scores and risk factors. Furthermore, patients’ uptake of the programme is substantively lower than the expected 70% target. Qualitative studies have highlighted that one way to understand these contradictory results might be how the programme is implemented locally. These studies have in fact found important variations in multiple dimensions, such as the staff conducting health checks, training, risk score, communication of advices and access to internal and external services. Taken together, current evidence emphasizes the need for more research that could provide less contradictory evidence on the effectiveness of NHS Health Checks as well as diverse type of research that could link information about the local variations in the implementation of the programme with quantitative indicators of effectiveness and uptake.
Drawing upon this concern, our project adopts a mixed methods approach with pursues two main objectives: (i) describe and assess the heterogeneity of Health Check programmes implemented within Local Authority areas and (ii) produce evidence on the link between these different local programmes and indicators of uptake, process outcomes and (where data permit) health outcomes. First, we investigate how the legal framework provided the “Regulations 2013” (which posited a unique implementation model) has been translated locally in different solutions. We seek to: identify the different implementation model that coexist in Coventry and Warwickshire; cluster these according to the nature of invitation (e.g. rate and type of invitation) and management (e.g. tests included; key players); explain why and how GP practices have developed their version of the programme (e.g. contingencies that motivated specific adaptations to the national model). Second, we develop statistical models to explain the predictors of uptake and process outcomes. The models will include predictors at multiple levels of analysis, such as properties of the eligible population (e.g. socio-demographics), of the provider (e.g. location, typology) and of the intervention. Differently from previous quantitative research, we will embed in the statistical model also predictors measuring variations in the local implementation of the programme, in order to highlight also if specific implementation model or organizational features are correlated with higher uptake or effectiveness.