Questions over
measurable outcomes have been a consistent feature of the NHS Health Check
debate since the programme was rolled out in 2009. Given the scope and ambition
of the service, as well the vocal opposition to it, articles calling for
evidence have become a regular feature in public health journals. In this post, we’ll be drawing attention to some of the empirical studies that are currently
informing the debate. Specifically, these studies focus on alternative delivery
methods, particularly via pharmacy.
A crucial factor to
bear in mind when considering the evidence is that despite the programme being
nationally mandated, there is no single mandated way of delivering it. The
systems in use across England vary widely in terms of the emphasis they place
on design, user-friendliness, and encouraging lifestyle improvement. The
studies cited here all use a patient-focussed solution developed by Health
Diagnostics. A demo of the software component of the solution may be watched here).
This evaluation
focussed on a service that was delivered by community pharmacists in Leicester
City.
In the introduction to
the research that was published in the Journal
of Public Health in March 2013, the rationale for evaluating the pharmacy-led
programme is explained:
‘‘In the past, risk screening
programmes have been exclusively undertaken within primary care sites. It has
been suggested that such an approach may widen health inequalities by excluding
those who do not routinely access organized health care… Subsequently, emphasis
has been placed on the importance of incorporating second sector organizations
in delivering a vascular risk assessment service’
This work thus assess precisely how important
it is to have a ‘many-pronged’ approach when tackling local health
inequalities. The study involved a sample of 2,521 individuals, which were recruited from
39 pharmacies. The method and
results may be read in full here.
In short, the
conclusions to the study spoke resoundingly in favour of pharmacy’s ability to
identify and engage with people that may otherwise slip under the radar:
‘‘Cardiovascular risk assessment led by community pharmacists can
successfully assess people from large, multi-ethnic UK populations and identify
those at high cardiovascular risk or with undiagnosed cardiovascular disease.
The service may improve rates of assessments undertaken by individuals who do
not access health care through traditional routes.’’
By way of a comment
on the particular advantages offered by pharmacy, the study’s authors noted:
‘‘The current study demonstrates the suitability of a pharmacy-led
system in including those from a minority ethnic background; perhaps due to the
extent to which pharmacies are integrated within local communities and their
ability to provide information in a number of languages and formats.’’
This second
study was carried out in the School of Pharmacy and Biomolecular Sciences at
Liverpool John Moores University. It engaged 10 pharmacies delivering the NHS
Health Check programme and was published in June 2010.
The report makes the following comment in
regard to the collated views on the pharmacy CVD screening service:
‘‘Almost
all of the participants had a positive experience of the screening process,
with 96 (99.7%) agreeing that they were given enough time for the screening and
that pharmacists made them feel at ease. Similar high numbers felt comfortable
discussing their lifestyle with the pharmacist. Indeed for many, their
expectations of what the screening would cover were exceeded. A further 91
(93.8%) participants agreed that the screening had been done in a suitable
place. However, nine (10.8%) had questions that were not discussed during their
consultation.’’
Seeing empirical research confirm that NHS
Health Checks are being well-delivered by providers outside of GP practices is
dispelling the myth that targeted lifestyle interventions can only be carried out by doctors. Given the strain that GP’s are under, as well as the
pressing need to raise widespread awareness about the importance and
practicalities of leading a healthy lifestyle, looking to the secondary sector should
really be something for local authorities across England to consider.
For further information or a localised appraisal of the potential impact of extending the provider network, contact Health Diagnostics at info@healthdiagnostics.co.uk or on 01244 311811. All reports are produced using evidence-based economic modelling.
