Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
BMJ Open. 2022 Nov 10;12(11):e064237. doi: 10.1136/bmjopen-2022-064237.
The NHS Health Check offers adults aged 40-74 an assessment of their risk of developing cardiovascular disease. Attendees should be offered appropriate clinical or behavioural interventions to help them to manage or reduce these risks. This project focused on understanding variation in the advice and support offered to Health Check attendees.
We conducted a realist review, assembling a diverse body of literature via database searches (MEDLINE, Embase, CINAHL, HMIC, Web of Science) and other search methods, and synthesised data extracted from documents using a realist logic of analysis. Our aim was to develop an understanding of contexts affecting delivery of the NHS Health Check and the underlying mechanisms producing outcomes related to the offer for attendees post-Check.
Our findings demonstrate differences in how NHS Health Check commissioners, providers and attendees understand the primary purpose of the programme. A focus on screening for disease can produce an emphasis on high-volume delivery in primary care. When delivery models are organised around behavioural approaches to risk reduction, more emphasis is placed on advice, and referrals to 'lifestyle services'. However, constrained funding and competing priorities for providers limit what can be delivered within the programme's remit. Attendees' experiences and responses to the programme are affected by how the programme is delivered, and by the difficulty of incorporating its outputs into their lives.
The remit of the NHS Health Check should be reviewed with consideration of what can be effectively delivered within existing resources. Variation in delivery may be appropriate to meet local needs, but differences in how the programme's primary purpose is understood contribute to a 'postcode lottery' in post-Check advice and support. Our findings underline existing concerns that the programme may generate inequitable outcomes and raise questions about whether it can deliver positive outcomes for the majority of attendees.
PROSPERO CRD42020163822.
国民保健制度（NHS）健康检查为 40-74 岁的成年人评估其患心血管疾病的风险。应向参与者提供适当的临床或行为干预措施，以帮助他们管理或降低这些风险。本项目重点关注了解向健康检查参与者提供的建议和支持的差异。
我们进行了一项现实主义审查，通过数据库搜索（MEDLINE、Embase、CINAHL、HMIC、Web of Science）和其他搜索方法，以及通过从文件中提取数据的现实主义逻辑分析，汇集了各种文献。我们的目的是了解影响国民保健制度健康检查交付的背景以及与检查后向参与者提供的服务相关的结果产生的潜在机制。
我们的研究结果表明，国民保健制度健康检查的委托方、服务提供者和参与者对该计划的主要目的有不同的理解。对疾病筛查的关注可能会导致在初级保健中强调大量提供服务。当交付模式围绕降低风险的行为方法组织时，更多的重点放在建议和转介到“生活方式服务”上。然而，提供者的资金有限和竞争优先事项限制了在该计划范围内可以提供的服务。参与者对该计划的体验和反应受到计划交付方式的影响，以及将该计划的成果纳入他们生活的困难程度的影响。
应考虑在现有资源范围内有效提供的内容，审查国民保健制度健康检查的范围。交付方式的差异可能适合满足当地需求，但对该计划主要目的的理解差异导致了检查后建议和支持的“邮政编码彩票”。我们的研究结果强调了该计划可能产生不公平结果的现有问题，并质疑该计划是否能够为大多数参与者带来积极的结果。
PROSPERO CRD42020163822。
