Population Health Sciences, University of Bristol, Bristol, UK
Population Health Sciences, University of Bristol, Bristol, UK.
BMJ Open. 2024 Nov 9;14(11):e091417. doi: 10.1136/bmjopen-2024-091417.
To compare the uptake, effectiveness and costs of a digital version of the National Health Service (NHS) Health Check (DHC) to the standard face-to-face NHS Health Check (F2F).
A random sample of 9000 patients aged 40-74 eligible for an NHS Health Check in Southwark, England, between January and April 2023.
The DHC was an online tool with a health assessment section, an advice and support section, and a section on how to obtain and update follow-up physical measures (blood pressure, cholesterol, glycated haemoglobin (HbA1c)). 6000 patients from GP records were randomly allocated to receive a DHC invitation and 3000 to receive an F2F invitation. Those invited to DHC were able to choose F2F if they preferred.
The primary outcome was the uptake of any type of health check, either a completed F2F appointment or completion of the DHC health assessment section, along with demographics and data on appointments, medications and referrals within the study period. QRISK3 and QDiabetes risk scores were calculated. Management and operation costs were estimated for F2F and DHC pathways.
Excluding participants who moved away or died, the DHC uptake to the health assessment section was 21% (1189/5705), with a further 3% (198/5705) choosing F2F, compared with 11% (305/2900) for F2F completion (p<0.001). The DHC uptake was lower among those from Black (14%) and Mixed (13%) compared with White (29%) ethnicities (p<0.001), and there was no evidence of higher DHC uptake among groups less likely to engage in NHS Health Checks. Of those who completed the health assessment, 60% (714) completed the support section, and 7% (84) completed the provision and updating of physical measures. Appointments, medications and referrals were lower among DHC service users than among F2F users (p<0.001). The estimated total management and operation costs for F2F were £154.80 per user, compared with total management and operation costs for DHC of £68.48 per user for health assessment only, £134.46 including the support section and £1479.01 per user with completed physical measures.
The study suggests that a choice of Health Check pathways may potentially reduce pressures on the NHS. Cholesterol and HbA1c were not generally known, and the options to obtain and update these measures require further development for the DHC to be considered a viable comparable alternative to the F2F service for estimating cardiovascular disease and diabetes risk. Strategies are still needed to reach those groups not currently engaging with NHS Health Checks.
This study was registered on the Open Science Framework: https://osf.io/y87zt.
比较数字版国民保健服务（NHS）健康检查（DHC）与标准面对面 NHS 健康检查（F2F）的接受程度、效果和成本。
2023 年 1 月至 4 月期间，在英格兰萨瑟克符合 NHS 健康检查条件的 9000 名 40-74 岁的患者中进行了一项随机抽样。
DHC 是一个在线工具，包括健康评估部分、咨询和支持部分，以及如何获取和更新后续身体测量（血压、胆固醇、糖化血红蛋白（HbA1c））的部分。从全科医生记录中随机分配 6000 名患者接受 DHC 邀请，3000 名患者接受 F2F 邀请。受邀参加 DHC 的人如果愿意，也可以选择 F2F。
主要结果是任何类型的健康检查的接受程度，包括完成 F2F 预约或完成 DHC 健康评估部分，以及研究期间的人口统计学和预约、药物和转诊数据。计算了 QRISK3 和 QDiabetes 风险评分。估计了 F2F 和 DHC 途径的管理和运营成本。
该研究表明，选择健康检查途径可能会降低 NHS 的压力。胆固醇和 HbA1c 通常不为人知，获取和更新这些措施的选项需要进一步开发，以便 DHC 被认为是 F2F 服务的可行替代方案，用于估计心血管疾病和糖尿病风险。仍需要制定策略来吸引那些目前未参与 NHS 健康检查的人群。
