国民保健服务健康检查计划：2009 - 2011年在伦敦东部的实施情况
The NHS Health Check programme: implementation in east London 2009-2011.
作者信息
Robson John, Dostal Isabel, Madurasinghe Vichithranie, Sheikh Aziz, Hull Sally, Boomla Kambiz, Page Helen, Griffiths Chris, Eldridge Sandra
机构信息
Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Centre for Population Health Sciences, the University of Edinburgh, Edinburgh, UK.
出版信息
BMJ Open. 2015 Apr 13;5(4):e007578. doi: 10.1136/bmjopen-2015-007578.
OBJECTIVES
To describe implementation and results from the National Health Service (NHS) Health Check programme.
DESIGN
Three-year observational open cohort study: 2009-2011.
PARTICIPANTS
People of age 40-74 years eligible for an NHS Health Check.
SETTING
139/143 general practices in three east London primary care trusts (PCTs) serving an ethnically diverse and socially disadvantaged population.
METHOD
Implementation was supported with education, IT support and performance reports. Tower Hamlets PCT additionally used managed practice networks and prior-stratification to call people at higher cardiovascular (CVD) risk first.
MAIN OUTCOMES MEASURES
Attendance, proportion of high-risk population on statins and comorbidities identified.
RESULTS
Coverage 2009, 2010, 2011 was 33.9% (31,878/10,805), 60.6% (30,757/18,652) and 73.4% (21,194/28,890), respectively. Older people were more likely to attend than younger people. Attendance was similar across deprivation quintiles and was in accordance with population distributions of black African/Caribbean, South Asian and White ethnic groups. 1 in 10 attendees were at high-CVD risk (20% or more 10-year risk). In the two PCTs stratifying risk, 14.3% and 9.4% of attendees were at high-CVD risk compared to 8.6% in the PCT using an unselected invitation strategy. Statin prescription to people at high-CVD risk was higher in Tower Hamlets 48.9%, than in City and Hackney 23.1% or Newham 20.2%. In the 6 months following an NHS Health Check, 1349 new cases of hypertension, 638 new cases of diabetes and 89 new cases of chronic kidney disease (CKD) were diagnosed. This represents 1 new case of hypertension per 38 Checks, 1 new case of diabetes per 80 Checks and 1 new case of CKD per 568 Checks.
CONCLUSIONS
Implementation of the NHS Health Check programme in these localities demonstrates limited success. Coverage and treatment of those at high-CVD risk could be improved. Targeting invitations to people at high-CVD risk and managed practice networks in Tower Hamlets improved performance.
目的
描述英国国家医疗服务体系（NHS）健康检查计划的实施情况及结果。
设计
2009 - 2011年为期三年的观察性开放队列研究。
参与者
年龄在40 - 74岁之间符合NHS健康检查条件的人群。
地点
伦敦东部三个初级医疗信托基金（PCT）中的139/143家全科诊所，服务于种族多样化且社会经济地位不利的人群。
方法
通过教育、信息技术支持和绩效报告来支持实施。陶尔哈姆莱茨PCT还利用管理实践网络和预先分层，首先召集心血管疾病（CVD）风险较高的人群。
主要观察指标
出勤率、服用他汀类药物的高危人群比例以及识别出的合并症。
结果
2009年、2010年、2011年的覆盖率分别为33.9%（31,878/94,085）、60.6%（30,757/50,752）和73.4%（21,194/28,890）。老年人比年轻人更有可能参加。各贫困五分位数人群的出勤率相似，且与非洲/加勒比黑人、南亚和白人种族群体的人口分布一致。每10名参加者中有1人处于高CVD风险（10年风险为20%或更高）。在两个对风险进行分层的PCT中，14.3%和9.4%的参加者处于高CVD风险，而采用未筛选邀请策略的PCT中这一比例为8.6%。陶尔哈姆莱茨对高CVD风险人群的他汀类药物处方率为48.9%，高于城市与哈克尼的23.1%或纽汉的20.2%。在NHS健康检查后的6个月内，诊断出1349例高血压新病例、638例糖尿病新病例和89例慢性肾病（CKD）新病例。这意味着每38次检查中有1例高血压新病例，每80次检查中有1例糖尿病新病例，每568次检查中有1例CKD新病例。
结论
在这些地区实施NHS健康检查计划成效有限。高CVD风险人群的覆盖率和治疗情况有待改善。针对高CVD风险人群发出邀请以及陶尔哈姆莱茨的管理实践网络提高了成效。
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