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Open Access Highly Accessed Research article

NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

Thomas Cochrane1*, Rachel Davey1, Zafar Iqbal2, Christopher Gidlow3, Jagdish Kumar2, Ruth Chambers2 and Yvonne Mawby2

Author Affiliations

1 Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, Canberra ACT2601, Australia

2 NHS Stoke on Trent, Directorate Public Health, Civic Centre, Glebe Street, Stoke on Trent, ST4 1HH, United Kingdom

3 Centre for Sport, Health and Exercise Research, Staffordshire University, Leek Road Campus, Stoke on Trent, ST4 2DF, United Kingdom

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BMC Public Health 2012, 12:944  doi:10.1186/1471-2458-12-944

Published: 1 November 2012

Abstract

Background

The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD) risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services.

Methods

Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support) patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking.

Results

Average population CVD risk decreased from 32.9% to 29.4% (p <0.001) in the NHS Health Check only group and from 31.9% to 29.2% (p <0.001) in the NHS Health Check plus additional lifestyle support group. There was no significant difference between the two groups at either measurement point. Prevalence of high blood pressure, high cholesterol and smoking were reduced significantly (p <0.01) in both groups. Prevalence of central obesity was reduced significantly (p <0.01) in the group receiving additional lifestyle support but not in the NHS Health Check only group.

Conclusions

The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

Keywords:
Vascular disease; Lifestyle change; Prevention; Multi-factorial risk; Policy implementation