What happens after an NHS Health Check? A survey and realist review.

Claire Duddy, Erica Gadsby, Vivienne Hibberd, Janet Krska, Geoff Wong
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引用次数: 0

Abstract

Background: The National Health Service Health Check in England aims to provide adults aged 40 to 74 with an assessment of their risk of developing cardiovascular disease and to offer advice to help manage and reduce this risk. The programme is commissioned by local authorities and delivered by a range of providers in different settings, although primarily in general practices. This project focused on variation in the advice, onward referrals and prescriptions offered to attendees following their health check.

Objectives: (1) Map recent programme delivery across England via a survey of local authorities; (2) conduct a realist review to enable understanding of how the National Health Service Health Check programme works in different settings, for different groups; (3) provide recommendations to improve delivery.

Design: Survey of local authorities and realist review of the literature.

Review methods: Realist review is a theory-driven, interpretive approach to evidence synthesis that seeks to explain why, when and for whom outcomes occur. We gathered published research and grey literature (including local evaluation documents and conference materials) via searching and supplementary methods. Extracted data were synthesised using a realist logic of analysis to develop an understanding of important contexts that affect the delivery of National Health Service Health Checks, and underlying mechanisms that produce outcomes related to our project focus.

Results: Our findings highlight the variation in National Health Service Health Check delivery models across England. Commissioners, providers and attendees understand the programme's purpose in different ways. When understood primarily as an opportunity to screen for disease, responsibility for delivery and outcomes rests with primary care, and there is an emphasis on volume of checks delivered, gathering essential data and communicating risk. When understood as an opportunity to prompt and support behaviour change, more emphasis is placed on delivery of advice and referrals to 'lifestyle services'. Practical constraints limit what can be delivered within the programme's remit. Public health funding restricts delivery options and links with onward services, while providers may struggle to deliver effective checks when faced with competing priorities. Attendees' responses to the programme are affected by features of delivery models and the constraints they face within their own lives.

Limitations: Survey response rate lower than anticipated; review findings limited by the availability and quality of the literature.

Conclusions and implications: The purpose and remit of the National Health Service Health Check programme should be clarified, considering prevailing attitudes about its value (especially among providers) and what can be delivered within existing resources. Some variation in delivery is likely to be appropriate to meet local population needs, but lack of clarity for the programme contributes to a 'postcode lottery' effect in the support offered to attendees after a check. Our findings raise important questions about whether the programme itself and services that it may feed into are adequately resourced to achieve positive outcomes for attendees, and whether current delivery models may produce inequitable outcomes.

Future work: Policy-makers and commissioners should consider the implications of the findings of this project; future research should address the relative scarcity of studies focused on the end of the National Health Service Health Check pathway.

Study registration: PROSPERO registration CRD42020163822.

Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR129209).

NHS健康检查后会发生什么?调查和现实主义评论。
背景:英国国家卫生服务健康检查旨在为40至74岁的成年人提供心血管疾病风险评估,并提供帮助管理和降低风险的建议。该方案由地方当局委托,由不同环境中的一系列提供者提供,尽管主要是在一般做法中。该项目重点关注健康检查后向参与者提供的建议、转诊和处方的变化。目标:(1)通过对地方当局的调查,绘制英格兰各地最近的方案交付情况图;(2) 进行现实主义审查,以了解国家卫生服务健康检查计划如何在不同环境下为不同群体开展工作;(3) 提供改进交付的建议。设计:地方当局的调查和文献的现实主义回顾。审查方法:现实主义审查是一种理论驱动的、解释性的证据综合方法,旨在解释结果发生的原因、时间和对象。我们通过检索和补充的方法收集了已发表的研究和灰色文献(包括当地评估文件和会议材料)。提取的数据使用现实主义分析逻辑进行综合,以了解影响国家卫生服务健康检查的重要背景,以及产生与我们项目重点相关结果的潜在机制。结果:我们的研究结果突出了英国国家医疗服务体系健康检查提供模式的差异。委员、提供者和与会者以不同的方式理解该计划的目的。当主要被理解为筛查疾病的机会时,交付和结果的责任在于初级保健,并强调交付的检查量、收集基本数据和沟通风险。当被理解为促进和支持行为改变的机会时,更强调提供建议和推荐“生活方式服务”。实际制约因素限制了在方案职权范围内可以提供的服务。公共卫生资金限制了提供选择和与后续服务的联系,而提供者在面临相互竞争的优先事项时可能难以提供有效的检查。与会者对该计划的反应受到交付模式的特点和他们在自己生活中面临的限制的影响。局限性:调查回复率低于预期;文献的可用性和质量限制了综述结果。结论和影响:应澄清国家卫生服务健康检查方案的目的和职权范围,考虑到对其价值的普遍态度(尤其是提供者之间)以及在现有资源范围内可以提供的服务。交付方面的一些变化可能适合满足当地人口的需求,但该计划缺乏明确性,导致在检查后向与会者提供的支持产生了“邮政编码抽签”效应。我们的研究结果提出了一个重要问题,即该计划本身及其可能提供的服务是否有足够的资源为参与者实现积极成果,以及当前的交付模式是否会产生不公平的结果。未来的工作:政策制定者和委员应考虑该项目调查结果的影响;未来的研究应该解决关注国家卫生服务健康检查途径结束的研究相对稀缺的问题。研究注册:PROSPERO注册CRD42020163822。资助:该项目由美国国立卫生与护理研究所(NIHR)卫生服务和交付研究计划(NIHR29209)资助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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