Delivery and impact of the NHS Health Check in the first eight years: a systematic review
The NHS Health Check programme was launched in England in 2009 to offer all individuals aged 40-74 years without pre-existing cardiovascular disease (CVD), chronic kidney disease, type 2 diabetes or dementia an assessment of their risk of having or developing such conditions and advice about relevant medications and lifestyle changes. In the Department of Health modelling it was envisaged that all eligible people would be invited during the first five years, 75% would attend and 85% of those with high cholesterol or CVD risk would be prescribed statins. Since 2009, however, uncertainty remains about who attends and the overall health impact. The aim of this study was to systematically identify and synthesize available evidence on: (1) coverage (the proportion of the eligible population who attend); (2) uptake (the proportion of invitees who attend); and (3) the effect of the programme on health-related outcomes.
We performed a systematic review and quantitative synthesis of published data and studies identified through a literature search of eleven databases (including Medline, Embase, OpenGrey) and other internet sources to November 2016. We included studies or data reporting coverage or uptake and studies reporting any health-related impact which used an appropriate comparison group or before-and-after study design. Data were extracted independently by three researchers and we used the Critical Appraisal Skills Programme (CASP) checklists to assess quality of included studies.
Twenty-six observational studies and one dataset were included. Since 2013, 45.6% of eligible individuals have received an NHS Health Check. This percentage varies across England with higher coverage among older people, those with a family history of coronary heart disease, those living in the most deprived areas, and some ethnic-minority groups. Just under half (48.2%) of those invited have taken up the invitation. Uptake is higher in older people and women but lower in those living in the most deprived areas. Attendance is associated with small increases in disease detection, decreases in modelled CVD risk and increases in statin and anti-hypertensive prescribing, with the percentage of those with a modelled 10-year CVD risk ≥20% prescribed statins following a health check ranging between 18.3% to 63%. Few studies have reported the impact of attendance on health-related behaviours and no economic evaluation was identified.
This study shows that the estimated coverage, uptake and prescribing rates used in the Department of Health model were optimistic: all are well above observed levels. Data on overall impact on health are limited but suggest that NHS Health Checks appear to have had a small effect on modelled cardiovascular risk via earlier detection of risk factors and increased prescribing.