A Quantitative Service Evaluation of a Telephone Outreach Initiative to Enhance the Uptake of NHS Health Checks

Problem

The NHS Health Check programme aims to identify cardiovascular (CV) risk in those aged 40-74, with the goal of reducing cardiovascular events and health inequalities.CV incident is higher in lower socioeconomic and ethnic minority groups.Invitations for a Checks are usually made via letter. However, research has indicated that telephone and verbal invitations increase likelihood of attendance. To address this and encourage the above groups to better engage with NHS Health Checks we adopted a novel approach compared to the usual invite. Our aim was to determine the efficacy of a targeted telephone outreach service for inviting patient from ‘hard to reach groups for an NHS health Check, in general practices located in the most deprived areas of Bristol.

Approach

Using a quasi-experimental approach, 12 general-practices self-selected to use the telephone outreach initiative (intervention). Specially trained, community-link workers contacted patients, and conducted aspects of the Check by phone. Following this, patient’s were invited to complete remaining aspects of their Check at their general-practice. Five practices acted as a control, using a letter, opportunistic or telephone call invitations; with no aspect of the Check being conducted during the telephone call.Primary outcome: Compare the rate of uptake of an NHS Health Check in the target population, in GP practices using the telephone outreach initiative, with the rate of uptake in control Secondary outcomes:Investigate the relationship between attendance and patient demographics (age, gender, IMD and ethnicity) in the target population.Descriptive statistics characterised populations and binary logistical regression tested associations between attendance for a health check and population characteristics.

Findings

Uptake was 24% and 35% in intervention versus control practices.Missing data precluded inclusion of ethnicity in regression models.Intervention practices were more successful at attracting ethnic minority patients to complete their Check (25.6%) compared to control practices (7.2%). In intervention practices after controlling for age, gender, IMD quintile and telephone-call outcome, age wasn’t a significant predictor of attendance; compared to women, men were significantly less likely to complete their Check (OR 0.75 95% CI 0.58 to 0.98); IMD was a significant predicator of attendance with those in the fifth IMD quintile being less likely to attend compared to those in the first IMD quintile (OR 0.64 95% CI 0.50 to 0.82).

Consequences

Despite this initiative being offered by the most deprived practices in Bristol, it attracted the least deprived patients. However, intervention practises were more successful at attracting patients from ethnic minorities. We only evaluated the first nine months of the initiative. Previous novel initiatives encouraging uptake of Health Checks, in Bristol, have shown a lagged adoption. Feedback on improvements, based on recommendations from this evaluation, may result in enhanced uptake from the intervention as it further embeds within practices.