Views of commissioners, managers and healthcare professionals on the NHS Health Check programme: a systematic review.

OBJECTIVE: To synthesise data concerning the views of commissioners, managers and healthcare professionals towards the National Health Service (NHS) Health Check programme in general and the challenges faced when implementing it in practice. DESIGN: A systematic review of surveys and interview studies with a descriptive analysis of quantitative data and thematic synthesis of qualitative data. DATA SOURCES: An electronic literature search of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the International Standard Randomised Controlled Trial Number registry from 1 January 1996 to 9 November 2016 with no language restriction and manual screening of reference lists of all included papers. INCLUSION CRITERIA: Primary research reporting views of commissioners, managers or healthcare professionals on the NHS Health Check programme and its implementation in practice. RESULTS: Of 18 524 citations, 15 articles met the inclusion criteria. There was evidence from both quantitative and qualitative studies that some commissioners and general practice (GP) healthcare professionals were enthusiastic about the programme, whereas others raised concerns around inequality of uptake, the evidence base and cost-effectiveness. In contrast, those working in pharmacies were all positive about programme benefits, citing opportunities for their business and staff. The main challenges to implementation were: difficulties with information technology and computer software, resistance to the programme from some GPs, the impact on workload and staffing, funding and training needs. Inadequate privacy was also a challenge in pharmacy and community settings, along with difficulty recruiting people eligible for Health Checks and poor public access to some venues. CONCLUSIONS: The success of the NHS Health Check Programme relies on engagement by those responsible for its commissioning, management and delivery. Recognising and addressing the challenges identified in this review, in particular the concerns of GPs, are important for the future of the programme

NHS Health Check Programme rapid evidence synthesis

Background: The NHS Health Check programme is the largest current prevention initiative in England. Since its introduction in 2009 a growing literature has been published evaluating the first eight years of the programme. These have been summarised in reports published by Public Health England but, to date, no synthesis has been performed. There is, therefore, a need for an independent, comprehensive, rapid evidence synthesis to identify what has been learnt about the NHS Health Check programme so far. Aims and Objectives: To provide a rapid synthesis of the published research evidence on NHS Health Checks, specifically addressing the six research questions posed by Public Health England: 1. Who is and who is not having an NHS Health Check? 2. What are the factors that increase take-up among the population and sub-groups? 3. Why do people not take up an offer of an NHS Health Check? 4. How is primary care managing people identified as being at risk of cardiovascular disease or with abnormal risk factor results? 5. What are patients’ experiences of having an NHS Health Check? 6. What is the effect of the NHS Health Check on disease detection, changing behaviours, referrals to local risk management services, reductions in individual risk factor prevalence, reducing cardiovascular disease risk and on statin and antihypertensive prescribing? Design: A systematic review with descriptive synthesis of quantitative data and thematic synthesis of qualitative data. Data sources: Medline, PubMed, Embase, Health Management Information Consortium (HMIC), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Global Health, PsycInfo, Web of Science, the Cochrane Library, NHS Evidence, Google Scholar, Google, OpenGrey, Clinical Trials.gov, the ISRCTN registry, and article reference lists. Study selection: Studies identified by the searches were selected for inclusion in the review by two reviewers in a two-step process. First, studies relevant to the NHS Health Check were identified. These were then screened against predefined inclusion and exclusion criteria for each of the six research questions. Data extraction: At least two researchers assessed eligibility, extracted data, and assessed the quality of the included studies. Key findings: Coverage varies substantially across regions and in different settings. Multiple definitions used interchangeably make comparisons difficult. It is consistently higher in older people, females and more deprived populations but this may reflect targeting. Outreach services in the community can reach particular socio-demographic groups but better descriptions and robust evaluations are needed. There is a lack of national level studies reporting the characteristics of those who take-up the invitation to an NHS Health Check. Regional studies report uptake between 27% and 53%, similar to national reported uptake (48.3%). Older people, women in younger age groups and men in older age groups, and those from least deprived areas are more likely to take up invitations. Promising methods to increase uptake are modifications to the invitation (3-4% increase), and text message invites or reminders (up to 9% increase). There is a lack of quantitative evidence for the effect of community settings on uptake but qualitative evidence highlights their convenience and the value of community ambassadors. People do not take up the offer of an NHS Health Check due to lack of awareness or knowledge, competing priorities, misunderstanding the purpose, an aversion to preventive medicine, difficulty getting an appointment with a GP, and concerns about privacy and confidentiality of pharmacies. Amongst attendees there are high levels of satisfaction (over 80%). Some reported attendance had acted as a wake-up call and precipitant for lifestyle changes. Others were left with feelings of unmet expectations, were confused about or unable to remember their risk scores, and found lifestyle advice too simplistic and un-personalised. There are wide variations in the process, delivery and content of NHS Health Checks across the country, in part due to different local implementation. Regardless of region or setting those delivering NHS Health Checks reported challenges with workload, IT, funding, and training. Amongst general practice professionals there were concerns about inequality of uptake and doubts about the evidence underpinning the programme and the cost-effectiveness. NHS Health Checks are associated with small increases in disease detection. There is very little data on behaviour change or referrals to lifestyle services. NHS Health Checks are associated with a 3-4% increase in prescribing of statins

Current and future cardiovascular disease risk assessment in the European Union: an international comparative study.

BACKGROUND: Risk assessment is central to primary prevention of cardiovascular disease (CVD), but there remains a need to better understand the use of evidence-based interventions in practice. This study examines: (i) the policies and guidelines for risk assessment in Europe, (ii) the use of risk assessment tools in clinical practice and (iii) the barriers to, and facilitators of, risk assessment. METHODS: Data were collected from academics, clinicians and policymakers in an online questionnaire targeted at experts from all European Union member states, and in 8 in-depth country case studies that were developed from a targeted literature review and 36 interviews. RESULTS: The European Society of Cardiology (ESC) produces European guidelines for CVD risk assessment and recommends the Systematic COronary Risk Evaluation tool, which is the most widely used risk assessment tool in Europe. The use of risk assessment tools is variable. Lack of time and resources are important barriers. Integrating risk assessment tools into clinical systems and providing financial incentives to carry out risk assessments could increase implementation. Novel biomarkers would need to be supported by evidence of their clinical effectiveness and cost-effectiveness to be introduced in clinical practice. These findings were consistent across Europe. CONCLUSIONS: Efforts to improve the assessment of CVD risk in clinical practice should be carried out by or in collaboration with, the ESC. Increasing the use of existing risk assessment tools is likely to offer greater gains in primary prevention than the development of novel biomarkers

Evaluating the Role and Contribution of Innovation to Health and Wealth in the UK: A Review of Innovation, Health and Wealth: Phase 1 Final Report.

The Department of Health's Innovation, Health and Wealth (IHW) strategy aimed to introduce a more strategic approach to the spread of innovation across the NHS. This study represents the first phase of a three-year evaluation and aims to map progress towards the IHW strategy and its component actions. This evaluation used a combination of quantitative and qualitative methods: document review, key informant interviews and stakeholder survey. This study also forms the basis for selecting case studies for phase two of the evaluation. Our findings from the interviews and survey suggest broad stakeholder support for the overarching ambitions of the IHW strategy. However, we found variable progress towards the overarching objectives of the eight IHW themes and an ambiguous relationship between many of the themes' objectives and their actions. It was difficult to assess progress on IHW's actions as commitment to the actions, implementation guidance and expected outcomes of the actions were not clearly articulated. The Academic Health Science Networks (AHSNs) and the Small Business Research Initiative (SBRI) were reported to be working well, which may be attributed to their clear structures of accountability and earmarked budgets. However, survey respondents and interviewees raised concerns that budgetary pressures may limit the impact of both AHSNs and the SBRI. The main challenges identified for ongoing action were the resources available for their implementation (e.g. Medtech Briefings), lack of awareness of the initiative (e.g. the NICE Implementation Collaborative) and the design of the actions (e.g. the Innovation Scorecard, web portal and High Impact Innovations)