Kumar Jagdish, Chambers Ruth, Mawby Yvonne, Leese Christopher, Iqbal Zafar, Picariello Linda, Richardson Deborah
NHS Stoke on Trent, Staffordshire, UK.
Qual Prim Care. 2011;19(3):193-9.
The NHS Health Check Programme presents the opportunity to reduce death and ill health caused by cardiovascular diseases (CVDs). Owing to the current restructuring of health care in the UK, financial resources will in future be limited. It is important to develop cost-effective ways of delivering this programme. There are practical alternatives to strategies that advocate using existing data to pre-stratify patients and prioritise those aged between 50 and 74 years.
Data on patients eligible for a health check were retrospectively collected from two early implementer practice teams. The characteristics of attenders and non-attenders, such as demographic factors, consulting behaviour, clinical measures and lifestyle measures, were collected. Costs of two approaches to delivery (drop-in clinic with choice of booked appointment versus booked appointment alone) were compiled.
Nearly half of all patients had accessed their GP or practice nurse with four or more appointments in the 12 months prior to their health check. There remained a margin of error between estimated CVD risk (calculated prior to the health check by the practice, using existing information) and actual CVD risk (calculated after a health check had been completed). Drop-in clinics with choice of booked appointment cost half the price of offering patients the option of booked appointments alone.
The cost-effectiveness of drop-in clinics was achieved by a reduction in staffing costs through intensively offering health checks; this approach provides a practical solution to maintaining a population-wide approach. Using existing data to pre-stratify patients is dependent on the quality and completeness of data used to estimate CVD risk. Concentrating efforts on 50 to 74 year olds may improve sensitivity to detect CVD but would reduce the chance of engaging with patients about their health at an earlier stage. Offering health checks opportunistically and using existing data no older than 12 months to complete a health check provide the potential for further cost savings.
英国国民健康服务（NHS）健康检查计划为降低心血管疾病（CVD）导致的死亡和健康问题提供了契机。由于英国目前的医疗保健结构调整，未来财政资源将受到限制。因此，开发具有成本效益的方式来实施该计划非常重要。对于那些主张利用现有数据对患者进行预分层并优先考虑50至74岁人群的策略，存在一些切实可行的替代方案。
从两个早期实施的实践团队中回顾性收集符合健康检查条件的患者数据。收集了就诊者和未就诊者的特征，如人口统计学因素、咨询行为、临床指标和生活方式指标。编制了两种实施方式（可选择预约的即到即看诊所与仅提供预约）的成本。
在进行健康检查前的12个月内，近一半的患者曾因四次或更多次预约就诊于全科医生（GP）或执业护士处。健康检查前由诊所根据现有信息计算的估计心血管疾病风险与健康检查完成后计算的实际心血管疾病风险之间仍存在误差范围。可选择预约的即到即看诊所的成本仅为仅为患者提供预约选项成本的一半。
即到即看诊所的成本效益是通过集中提供健康检查来降低人员成本实现的；这种方法为维持全人群覆盖的方式提供了切实可行的解决方案。利用现有数据对患者进行预分层取决于用于估计心血管疾病风险的数据质量和完整性。将工作重点集中在50至74岁人群可能会提高检测心血管疾病的敏感性，但会减少在更早阶段与患者就其健康问题进行沟通的机会。机会性地提供健康检查并使用不超过12个月的现有数据来完成健康检查有进一步节省成本的潜力。
