Fostering a more collaborative approach to the NHS Health Check through improved online access to results: The CaVIAR Project (better Care Via Improved Access to Results)
Problem
Following an initial NHS Health Check appointment, NICE Guidance suggests patients with QRISK® scores of ≥ 10% should be offered lifestyle advice and a discussion regarding the risks and benefits of starting a statin. NICE recommend we should ascertain patients’ pre-existing knowledge of CVD risk, explore health beliefs, assess readiness to change lifestyle, offer support, and engage family members. Condensing this complex discussion into a 10 minute consultation may result in inadequate patient understanding of the benefits of preventive measures. An alternative approach is needed.
Approach
We propose a digital adjunct to the NHS Health Check to give patients the opportunity to interact with their health check results from home, before returning to see their GP. This could facilitate a more informed and collaborative subsequent consultation. We gathered the views of patients and the public to help review our proposed approach, and identify possible challenges, solutions and improvements. We first consulted PRIMER, an established departmental Patient and Public Involvement (PPI) group (N=9) and then ran a workshop involving 19 members of the public, co-facilitated by 4 members of PRIMER. Following a brief presentation about the NHS Health Check and the background to the project, participants were split into four groups and introduced to Ketso®, a toolkit for creative engagement. Ketso® was used to encourage and record group discussions regarding the proposal in order to inform intervention development and a future funding bid.
Findings
The discussions focussed around three main themes: 1) positive feedback, 2) problems and solutions, 3) improvements/alternatives. Positive feedback included benefits to the NHS (e.g. cost savings), and patient benefit (e.g. use of the platform as a communication aid). The four main problem areas identified related to: 1) access (e.g. for those with disabilities), 2) data security (e.g. concerns re: insurance companies accessing data), 3) engagement (e.g. lack of interest), and 4) negative consequences (e.g. increased patient anxiety). Workshop members generated various solutions to these potential problems. For example a ‘speak aloud’ option on the platform to improve access, assurances that life insurance companies could not access encrypted data, community ‘champions’ to encourage engagement, and a helpline for those anxious about their results. Workshop members made additional suggestions to improve the project regarding; 1) population (e.g. also including those with QRISK scores ≤ 10%), 2) duration (e.g. ongoing access to provide continued feedback), and 3) platform content (e.g. provision of signposting to stop smoking/weight loss services).
Consequences
This PPI work raised many issues and helped identify potential problems and solutions not previously considered by the research team. Findings from this initial work will inform subsequent intervention design and a future bid for funding. We aim to ensure ongoing patient and public involvement in all future stages of the project.