Institute of Cardiovascular Science, University College London, London, UK
Public Health England, London, UK.
BMJ Open. 2020 Nov 5;10(11):e042963. doi: 10.1136/bmjopen-2020-042963.
To describe the uptake and outputs of the National Health Service Health Check (NHSHC) programme in England.
Observational study.
National primary care data extracted directly by NHS Digital from 90% of general practices (GP) in England.
Individuals aged 40-74 years, invited to or completing a NHSHC between 2012 and 2017, defined using primary care Read codes.
The NHSHC, a structured assessment of non-communicable disease risk factors and 10-year cardiovascular disease (CVD) risk, with recommendations for behavioural change support and therapeutic interventions.
During the 5-year cycle, 9 694 979 individuals were offered an NHSHC and 5 102 758 (52.6%) took up the offer. There was geographical variation in uptake between local authorities across England ranging from 25.1% to 84.7%. Invitation methods changed over time to incorporate greater digitalisation, opportunistic delivery and delivery by third-party providers.The population offered an NHSHC resembled the English population in ethnicity and deprivation characteristics. Attendees were more likely to be older and women, but were similar in terms of ethnicity and deprivation, compared with non-attendees. Among attendees, risk factor prevalence reflected population survey estimates for England. Where a CVD risk score was documented, 25.9% had a 10-year CVD risk ≥10%, of which 20.3% were prescribed a statin. Advice, information and referrals were coded as delivered to over 2.5 million individuals identified to have risk factors.
This national analysis of the NHSHC programme, using primary care data from over 9.5 million individuals offered a check, reveals an uptake rate of over 50% and no significant evidence of inequity by ethnicity or deprivation. To maximise the anticipated value of the NHSHC, we suggest continued action is needed to invite more eligible people for a check, reduce geographical variation in uptake, prioritise engagement with non-attendees and promote greater use of evidence-based interventions especially where risk is identified.
描述英国国民保健服务健康检查（NHSHC）计划的参与情况和产出。
观察性研究。
英国国民保健系统数字（NHS Digital）直接从英格兰 90%的全科医生（GP）中提取的国家初级保健数据。
年龄在 40-74 岁之间的个体，在 2012 年至 2017 年期间接受或完成 NHSHC 检查，使用初级保健阅读代码定义。
NHSHC 是一种对非传染性疾病风险因素和 10 年心血管疾病（CVD）风险的结构化评估，同时提供行为改变支持和治疗干预建议。
在 5 年周期内，有 9694979 人接受了 NHSHC 检查，其中 5102758 人（52.6%）接受了检查。英格兰各地地方当局之间的参与率存在地域差异，从 25.1%到 84.7%不等。邀请方法随着时间的推移发生了变化，越来越多地采用数字化、机会性提供和第三方提供商提供的方式。接受 NHSHC 检查的人群在种族和贫困特征上与英国人口相似。参与者更可能年龄较大且为女性，但与未参与者相比，在种族和贫困方面相似。在参与者中，风险因素的流行率反映了英格兰的人口调查估计。在记录 CVD 风险评分的情况下，25.9%的人有 10 年 CVD 风险≥10%，其中 20.3%的人被开了他汀类药物。为超过 250 万人编码提供了建议、信息和转介，这些人被确定存在风险因素。
本研究使用来自 950 多万名接受检查的个体的初级保健数据，对 NHSHC 计划进行了全国性分析，结果显示参与率超过 50%，且没有证据表明种族或贫困程度存在差异。为了最大限度地发挥 NHSHC 的预期价值，我们建议继续采取行动邀请更多符合条件的人进行检查，减少参与率的地域差异，优先与未参与者接触，并促进更广泛地使用基于证据的干预措施，特别是在发现风险的情况下。
