Dachsel Martin, Lee Eugenia
Acute Medicine Trainee, Kent and Sussex Hospital, Tunbridge Wells, UK.
GP, Thamesmead Medical Associates, London, UK.
London J Prim Care (Abingdon). 2011 Jul;4(1):5-10. doi: 10.1080/17571472.2011.11493321.
Cardiovascular disease remains common and accounts for many deaths, but primary cardiovascular risk factors are consistently underdiagnosed in the UK. NHS health checks are being implemented nationally in the next five years, targeting those aged 40 to 74 years, and many primary care trusts have commissioned health checks to be carried out opportunistically as an outreach programme in public places to aid uptake and improve access. However, there is little published evidence on the effectiveness and subsequent follow-up rates in such a model. This service evaluation verifies the effectiveness of primary cardiovascular screening in a supermarket setting in south east London. Eight consecutive Saturday clinics were carried out at the entrance of a local supermarket offering opportunistic health screening including blood pressure, random glucose, body mass index and screening spirometry. The primary outcomes are rate of uptake of the service, the proportion of participants with previously undiagnosed cardiovascular risk factors that were identified from the screening, and the subsequent rate of follow-up. Over the eight-week period, 1024 participants (457 males, 44.6%; 567 females 567, 55.4%) undertook the screening. Four hundred and twenty-two participants (41.2%) required follow-up for abnormal readings. Of these, 325 (76.4%) were abnormal readings in participants with previously unknown disease (raised blood glucose, 95 participants (9.3%); raised blood pressure, 172 participants (16.8%); FEV1 < 80%, 93 participants (9.1%)). Using the NHS health check age range, 34.3% of raised blood pressure measurements and 38.9% of raised blood glucose measurements would not have been picked up. The cost per patient was £19, the cost per abnormal finding was £43.66. Opportunistic health screening targeting particular groups of individuals appears to be highly effective in identifying significant pathology. The main limitation of this pilot was that cholesterol measurement was not performed and therefore full cardiovascular risk assessment could not be offered.
心血管疾病仍然很常见，是导致许多人死亡的原因，但在英国，主要心血管风险因素一直未得到充分诊断。国民保健署（NHS）的健康检查计划将在未来五年内在全国推行，目标人群是40至74岁的人群，许多初级医疗信托机构已委托开展机会性健康检查，作为一项在公共场所的外展项目，以促进参与并改善可及性。然而，关于这种模式的有效性及后续随访率，几乎没有公开的证据。这项服务评估验证了在伦敦东南部一家超市进行的初级心血管筛查的有效性。在当地一家超市入口处连续开展了八次周六门诊，提供机会性健康筛查，包括血压、随机血糖、体重指数和筛查肺功能测定。主要结果包括该服务的参与率、筛查中发现的既往未诊断心血管风险因素的参与者比例，以及后续随访率。在为期八周的时间里，1024名参与者（457名男性，占44.6%；567名女性，占55.4%）接受了筛查。422名参与者（41.2%）因检查结果异常需要随访。其中，325名（76.4%）是既往未知疾病参与者的异常结果（血糖升高，95名参与者（9.3%）；血压升高，172名参与者（16.8%）；第一秒用力呼气容积（FEV1）<80%，93名参与者（9.1%））。按照国民保健署健康检查的年龄范围，34.3%的血压升高测量值和38.9%的血糖升高测量值将不会被检测到。每位患者的成本为19英镑，每个异常检查结果的成本为43.66英镑。针对特定人群的机会性健康筛查在识别重大病理方面似乎非常有效。该试点的主要局限性在于未进行胆固醇测量，因此无法提供全面的心血管风险评估。
