title: Uptake of the NHS Health Check programme in an urban setting.
abstract: BACKGROUND
  The NHS Health Check programme aims to improve prevention, early diagnosis and management of cardiovascular disease (CVD) in England. High and equitable uptake is essential for the programme to effectively reduce the CVD burden.
  
  
  OBJECTIVE
  Assessing the impact of a local financial incentive scheme on uptake and statin prescribing in the first 2 years of the programme.
  
  
  METHODS
  Cross-sectional study using data from electronic medical records of general practices in Hammersmith and Fulham, London on all patients aged 40-74 years. We assessed uptake of complete Health Check, exclusion of patients from the programme (exception reporting) and statin prescriptions in patients confirmed with high CVD risk.
  
  
  RESULTS
  The Health Check uptake was 32.7% in Year 1 and 20.0% in Year 2. Older patients had higher uptake of Health Check than younger (65- to 74-year-old patients: Year 1 adjusted odds ratio (AOR) 2.05 (1.67-2.52) & Year 2 AOR 2.79 (2.49-3.12) compared with 40- to 54-year-old patients). The percentage of confirmed high risk patients prescribed a statin was 17.7% before and 52.9% after the programme. There was a marked variation in Health Check uptake, exception reporting and statin prescribing between practices.
  
  
  CONCLUSIONS
  Uptake of the Health Check was low in the first year in patients with estimated high risk despite financial incentives to general practices; although this matched the national required rate in second year. Further evaluations for cost and clinical effectiveness of the programme are needed to clarify whether this spending is appropriate, and to assess the impact of financial incentives on programme performance.
authors: Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3rd Floor, Reynolds Building, St. Dunstan's Road, London W6 8RP, UK. macide.artac08@imperial.ac.uk
authors: Macide
authors: M
authors: Artac
authors: Andrew R H
authors: AR
authors: Dalton
authors: Azeem
authors: A
authors: Majeed
authors: Josip
authors: J
authors: Car
authors: Kit
authors: K
authors: Huckvale
authors: Christopher
authors: C
authors: Millett
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D058006:General Practice / Q000191:economics / Q000379:methods; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000379:methods; D015397:Program Evaluation; D018570:Risk Assessment; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology; D019037:Urban Health Services
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; primary care; primary prevention; risk assessment; screening.
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