Study probes effect of NHS Health Checks
"Health MOTs routinely offered to over-40s on the NHS may be a waste of time," the Mail Online reports.
The report says researchers have found no difference in the prevalence of diseases such as diabetes in GP practices that offer NHS Health Checks and those that don't.
NHS Health Checks were introduced in 2009 and are designed to act as a midlife "MOT" (as the Mail describes it).
This study compared GP practices in Warwickshire that implemented NHS Health checks between 2010 and 2013 with those that did not.
They looked at whether the checks increased numbers of diagnoses of five chronic conditions: heart disease, high blood pressure, diabetes, chronic kidney disease and heart rhythm abnormality (atrial fibrillation).
Changes in the number of cases of these five chronic diseases were very small and there was no significant difference between practices with or without checks. But the study did not recruit a large enough sample to be able to reliably detect differences.
The study period was also quite short. Proponents of the NHS Health Check argue any benefits may not be noticeable for a decade.
The study has not been able to examine other health benefits that may result from the checks. For example, it could be the case some people who attend a health check receive lifestyle advice that could help prevent the future development of chronic disease.
Overall, further research in larger samples and over longer time periods is needed to examine whether the NHS Health Checks are of any benefit in improving the detection of chronic disease, or have any other beneficial health outcomes.
Where did the story come from?
The study was carried out by researchers in the fields of public health and general practice in Warwickshire, and was published in the peer-reviewed British Journal of General Practice. No sources of funding are reported and the authors declare no conflicts of interest.
Overall, the Mail Online's and The Times' reporting of the study was accurate.
What kind of research was this?
This was a non-randomised controlled study in a mixed urban and rural population of England, designed to examine the impact of NHS Health Checks on the detection of:
- hypertension
- coronary heart disease
- chronic kidney disease
- diabetes
- atrial fibrillation (a heart rhythm abnormality)
The NHS Health Check, introduced by the Department of Health in 2009, is sometimes called the "midlife MOT". NHS Health Checks are offered to people between the ages of 40 and 74 who haven't already been diagnosed with these health conditions.
An NHS Health Check includes questions about your lifestyle and family history of disease, as well as tests to measure your cholesterol, blood pressure, BMI and diabetes risk. It also looks at risk of vascular dementia, although this is not covered in the current study.
Your risk of developing a cardiovascular condition is calculated using a standard online calculator called the QRISK calculator. The checks are usually carried out by a nurse or trained healthcare assistant.
If a condition is detected or the person is at risk of developing a condition, they are referred to the GP for further assessment and treatment.
The researchers say no research has yet been published assessing the impact of NHS Health Checks on the number of cases of these diseases (their prevalence) in GP practices.
If the checks detect extra cases that would otherwise not be detected, then you would expect to see the prevalence of these conditions increasing.
To do this, the researchers compared the changes in disease prevalence among GP practices that have implemented the health checks with those that haven't.
What did the research involve?
The study looked at 38 GP practices in Warwickshire, which provided NHS Health Checks over a three-year period between June 2010 and March 2013.
It compared data from these GP practices with 41 practices within Coventry and Warwickshire that did not provide the health checks.
The researchers collected data from each practice on the number of NHS Health Checks offered and completed, and the number of new cases of diabetes, hypertension, coronary heart disease, chronic kidney disease and atrial fibrillation that were detected as a direct result of the checks.
No specific set of diagnostic criteria were used in the study to confirm the presence of these conditions – practices were expected to identify and report a case of disease using their usual diagnostic criteria.
The prevalence of the conditions for all practices diagnosed through usual medical care was obtained from the national disease registers maintained as part of a national programme to measure quality of care, called the Quality and Outcomes Framework (QOF).
The prevalence of disease at the start of the study was obtained for the financial year 2009-10 (ending March 2010), and at the end of the study for the financial year 2012-13 (ending March 2013).
When comparing prevalence in different practices, the researchers took into account practice size, average age of the population, proportion of males, baseline prevalence of disease, and how deprived the area was.
What were the basic results?
A total of 1,142 new cases of disease were detected through the NHS Health Checks programme from 16,669 checks. This is equivalent to one disease case being detected in 6.85% of all health checks.
Most of these newly detected cases were high blood pressure (635), followed by diabetes (210) and chronic kidney disease (198), with fewer cases of coronary heart disease and atrial fibrillation detected.
There were no significant differences between practices with and without health checks for the change in prevalence of any of the chronic diseases between 2009-10 and 2012-13.
Other factors also influenced the change in prevalence over the study period, including how common the disease was at the start of the study, average age of population, practice size, proportion of males and deprivation.
How did the researchers interpret the results?
The researchers conclude that, "In practices providing NHS Health Checks, the change in the reported prevalence of diabetes, hypertension, coronary heart disease, chronic kidney disease, and atrial fibrillation did not differ from that of practices providing usual care."
Conclusion
This study compared practices in the Warwickshire and Coventry area who implemented NHS Health Checks between June 2010 and March 2013, with those that did not provide the health checks and gave their usual care only.
A total of 1,142 new cases of disease were detected through the NHS Health Check programme from 16,669 checks. Changes in prevalence over the study period were small – in fact, less than 0.7%.
For diabetes, chronic kidney disease and heart disease, prevalence in both groups decreased over the study period.
Meanwhile, high blood pressure and atrial fibrillation increased in both groups during the study, and increased slightly more in the health check group (0.46% increase compared with 0.30% increase).
However, there was no statistically significant difference between practices who did or did not implement health checks in terms of the change in prevalence of the five chronic diseases during the three-year study period.
The researchers say the results imply NHS Health Checks in GP practices may not increase the reported prevalence of the five conditions examined, despite the apparent detection of disease (one disease case being detected in 6.85% checks). This may mean GP practices' standard care is good at detecting these conditions.
However, there are some limitations to the study, as the researchers do acknowledge:
- The study was unable to recruit the number of GP practices they needed to give sufficient statistical ability ("power") to detect the expected differences between the groups (79 of the target of 311 practices). This meant the study only had about a 35% chance of detecting a difference in change in prevalence between the practices of 2% or more.
- It is not possible to know whether the health outcomes for people who have these conditions identified and treated as a result of an NHS Health Check may be any different from those detected through usual care.
- The study itself did not specify diagnostic criteria for the diseases, which may mean practices differed in the way they diagnosed the conditions. There were also differences in the completeness of practices' records.
- Because the practices were not randomly assigned to provide or not provide health checks, the groups cannot be guaranteed to be balanced for characteristics other than the health checks that might affect the results.
- The study did try to take some of these characteristics into account (such as the number of patients the practice looks after and average age of the population), but there may be other characteristics having an effect, such as the ethnicity of the population.
- The overall uptake of health checks was fairly low, at only 13.6% of all those eligible during the three-year study period. However, as the researchers say, this is reasonably similar to the national average uptake (3.1% in 2011 to 2012, increasing to 8.1% in 2012 to 2013).
The study also only examined the Coventry and Warwickshire region of the UK. Practices in other regions may have different results. It also only examined a three-year period.
And, importantly, the study is unable to detect any possible health benefits that may result from the health checks, outside of identifying people who currently have these five chronic diseases.
For example, the health check may lead to greater awareness and discussion of a person's BMI, diet, cholesterol, physical activity, smoking and alcohol intake.
This could lead to the person making healthy lifestyle changes that could then decrease their risk of actually developing these chronic diseases. Studies would be needed to see if there had been any effect on these other outcomes.
As the researchers conclude, "studies directly comparing the effect of NHS Health Checks with usual care are lacking and must be the primary focus for further research in this area".
