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Health checks in general practice: another example of inverse care?
Insights
Less than half of eligible patients attended cardiovascular disease health checks, with attendance inversely related to risk factors like smoking and poor diet. Targeted public health strategies are needed for effective cardiovascular disease prevention.
Area of Science:
- Public Health
- Preventive Medicine
- General Practice
Background:
- Cardiovascular disease (CVD) prevention strategies are crucial in primary care.
- Health checks aim to identify and manage CVD risk factors.
- Long-term attendance patterns for general practice-based CVD health checks are not well-established.
Purpose of the Study:
- To evaluate patient attendance rates for cardiovascular disease health checks over five years.
- To identify patient characteristics associated with attendance versus non-attendance.
- To understand the relationship between CVD risk factors and health check uptake.
Main Methods:
- A five-year medical record audit and postal questionnaire survey were conducted.
- The study included 1101 men and 1110 women aged 35-64 in a single Oxfordshire general practice.
- Data collected included age, sex, marital status, social class, smoking, alcohol consumption, and diet.
Main Results:
- Overall attendance was 43.6% (963/2211) after five years of offering checks.
- Attenders were more likely to be women, aged ≥45, married, non-smokers, and of higher social class.
- Non-attendance risk increased with smoking (1.24), being overweight (1.20), heavy drinking (1.16), and poor diet (1.28), adjusted for demographics.
Conclusions:
- Less than half of eligible patients attended cardiovascular disease health checks over five years.
- Attendance likelihood decreased with increasing cardiovascular risk factors, except for age.
- Effective CVD reduction requires targeted resource allocation, public health measures (e.g., dietary regulation, tobacco taxation), and caution against unproven individual interventions.
Objective:
To assess attendance at and the characteristics of patients attending health checks for cardiovascular disease offered in a general practice over a period of five years (1984-9).
Design:
Medical record audit and postal questionnaire survey.
Setting:
One general practice in Oxfordshire with a socially diverse population.
Participants:
1101 Men and 1110 women aged 35-64 registered with the practice.
Main Outcome Measures:
Age, sex, marital state, social class, smoking habits, alcohol consumption, and diet.
Results:
Of the 2211 men and women in the target age group (35-64) in 1989, 1458 (65.9%) had been offered screening and 963 (43.6%) had attended for a health check. Attenders were more likely to be women, aged greater than or equal to 45, married, non-smokers, and of higher social class than patients who did not respond to the invitation. The relative likelihood of non-attendance was 1.24 for smokers, 1.20 for the overweight, 1.16 for heavy drinkers, and 1.28 for those with a less healthy diet, even after adjustment for age, sex, marital state, and social class.
Conclusions:
After five years of offering health checks, opportunistically (to men) and in the context of cervical smear tests (to women), less than half of the eligible patients had attended. The likelihood of acceptance of an invitation to attend was inversely related to the patient's cardiovascular risk for all factors measured except age. A coherent strategy to reduce cardiovascular disease depends on more careful targeting of scarce health service resources and more emphasis on public health measures (such as dietary regulation and tobacco taxation). Doctors should be careful not to absolve the government of its public health obligations by substituting unproved preventive interventions aimed at the individual patient.