Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary pre... more Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary prevention programme globally, aims to reduce CVD burden and health inequalities by assessing and managing CVD risk among 40 to 74 year old individuals without existing vascular diseases. I evaluated the impact of the programme at local and national levels. Methods: Using electronic medical record data from general practices in Hammersmith and Fulham, I assessed CVD risk factor recording before the programme, the programme uptake in the first two years and the impact of the programme on CVD risk. National coverage of the programme in one financial year was assessed using data from Primary Care Trusts (PCTs). Results: There was good recording of smoking status (86.1%) and blood pressure (82.5%), with lower BMI (59.5%) and cholesterol (47.5%) recording among Health Check eligible patients before the programme in Hammersmith and Fulham. Uptake of the Health Check was lower than the national target (75%) at 39.2% among patients with an estimated high CVD risk, but matched the national required rate at 20.0% among all remaining eligible patients. There was significant reduction in mean global CVD risk score (28.2% to 26.2%) after one year among patients with estimated high risk that had a complete Health Check. The programme uptake was higher in patients living in more deprived areas among those not at estimated high risk (adjusted odds ratio = 0.88 (0.73-106)). Mean national coverage of the programme was lower (8.1%) than anticipated (18%), with large PCT-level variation (0% to 29.8%). Coverage was significantly greater in PCTs in more deprived areas (coefficient = -0.51 (-1.88-0.00), p-value: 0.035). Conclusions: Population-wide impact of the NHS Health Check may be limited by poor uptake of the programme. This and other limitations to the programme suggest that a targeted screening approach along with population-wide strategies may be a better option for more cost-effective prevention of CVD.
Objectives To assess the completeness of cardiovascular disease (CVD) risk factor recording and l... more Objectives To assess the completeness of cardiovascular disease (CVD) risk factor recording and levels of risk factors in patients eligible for
Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary pre... more Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary prevention programme globally, aims to reduce CVD burden and health inequalities by assessing and managing CVD risk among 40 to 74 year old individuals without existing vascular diseases. I evaluated the impact of the programme at local and national levels. Methods: Using electronic medical record data from general practices in Hammersmith and Fulham, I assessed CVD risk factor recording before the programme, the programme uptake in the first two years and the impact of the programme on CVD risk. National coverage of the programme in one financial year was assessed using data from Primary Care Trusts (PCTs). Results: There was good recording of smoking status (86.1%) and blood pressure (82.5%), with lower BMI (59.5%) and cholesterol (47.5%) recording among Health Check eligible patients before the programme in Hammersmith and Fulham. Uptake of the Health Check was lower than the national target (75%) at 39.2% among patients with an estimated high CVD risk, but matched the national required rate at 20.0% among all remaining eligible patients. There was significant reduction in mean global CVD risk score (28.2% to 26.2%) after one year among patients with estimated high risk that had a complete Health Check. The programme uptake was higher in patients living in more deprived areas among those not at estimated high risk (adjusted odds ratio = 0.88 (0.73-106)). Mean national coverage of the programme was lower (8.1%) than anticipated (18%), with large PCT-level variation (0% to 29.8%). Coverage was significantly greater in PCTs in more deprived areas (coefficient = -0.51 (-1.88-0.00), p-value: 0.035). Conclusions: Population-wide impact of the NHS Health Check may be limited by poor uptake of the programme. This and other limitations to the programme suggest that a targeted screening approach along with population-wide strategies may be a better option for more cost-effective prevention of CVD.
SummaryObjectives To assess the completeness of cardiovascular disease(CVD) risk factor recording... more SummaryObjectives To assess the completeness of cardiovascular disease(CVD) risk factor recording and levels of risk factors in patients eligible forthe NHS Health Check.Design Cross-sectional study.Setting Twenty-eight general practices located in Hammersmith andFulham, London, UK.Participants 42,306 patients aged 40 to 74 years without existingcardiovascular disease or diabetes.Main Outcome Measures Measurement and level of CVD riskfactors: blood pressure, cholesterol, body mass index (BMI), bloodglucose and smoking status.Results There was a high recording of smoking status (86.1%) andbloodpressure(82.5%);whilstBMI,cholesterolandglucoserecordingwaslower. There was large variation in BMI, cholesterol, glucose recordingbetween practices (29.7–91.5% for BMI). Women had significantly betterrisk factor recording than men (AOR = 1.70 [1.61–1.80] for bloodpressure).Allriskfactorswerebetterrecorded inthe leastdeprivedpatientgroup (AOR = 0.79 [0.73–0.85] for blood pressure) and patients wi...
International Journal of Health Management and Tourism, 2019
The issue of maternal mortality in the developing world is still a major concern for health plann... more The issue of maternal mortality in the developing world is still a major concern for health planners and policymakers. This systematic review was done keeping in view the high maternal mortality rates in Nigeria, to identify the major direct and indirect causes and thus enable us to understand the gaps between what is and what ought to be. For this purpose, the published work was reviewed by searching the PubMed and BioMed Central databases for retrospective maternal mortality reviews and autopsies after the year 2000. Of 69 articles, 11 full-text articles were reviewed and six of them were finally included in the study. Eclampsia, pre-eclampsia, and hemorrhage were reported to be the most common direct causes of maternal mortality, all of which are preventable by simple maneuvers like regular antenatal checkups, early detection, presence of trained birth attendants to assist with the delivery, easy access to health facilities, etc. There is a need to increase the utilization of ant...
• Despite a number of limitations to our study findings, we were careful in interpreting the find... more • Despite a number of limitations to our study findings, we were careful in interpreting the findings and presented them in a balanced manner.
Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary pre... more Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary prevention programme globally, aims to reduce CVD burden and health inequalities by assessing and managing CVD risk among 40 to 74 year old individuals without existing vascular diseases. I evaluated the impact of the programme at local and national levels. Methods: Using electronic medical record data from general practices in Hammersmith and Fulham, I assessed CVD risk factor recording before the programme, the programme uptake in the first two years and the impact of the programme on CVD risk. National coverage of the programme in one financial year was assessed using data from Primary Care Trusts (PCTs). Results: There was good recording of smoking status (86.1%) and blood pressure (82.5%), with lower BMI (59.5%) and cholesterol (47.5%) recording among Health Check eligible patients before the programme in Hammersmith and Fulham. Uptake of the Health Check was lower than the national target (75%) at 39.2% among patients with an estimated high CVD risk, but matched the national required rate at 20.0% among all remaining eligible patients. There was significant reduction in mean global CVD risk score (28.2% to 26.2%) after one year among patients with estimated high risk that had a complete Health Check. The programme uptake was higher in patients living in more deprived areas among those not at estimated high risk (adjusted odds ratio = 0.88 (0.73-106)). Mean national coverage of the programme was lower (8.1%) than anticipated (18%), with large PCT-level variation (0% to 29.8%). Coverage was significantly greater in PCTs in more deprived areas (coefficient = -0.51 (-1.88-0.00), p-value: 0.035). Conclusions: Population-wide impact of the NHS Health Check may be limited by poor uptake of the programme. This and other limitations to the programme suggest that a targeted screening approach along with population-wide strategies may be a better option for more cost-effective prevention of CVD.
Objectives To assess the completeness of cardiovascular disease (CVD) risk factor recording and l... more Objectives To assess the completeness of cardiovascular disease (CVD) risk factor recording and levels of risk factors in patients eligible for
Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary pre... more Background: The NHS Health Check, the largest systematic cardiovascular disease (CVD) primary prevention programme globally, aims to reduce CVD burden and health inequalities by assessing and managing CVD risk among 40 to 74 year old individuals without existing vascular diseases. I evaluated the impact of the programme at local and national levels. Methods: Using electronic medical record data from general practices in Hammersmith and Fulham, I assessed CVD risk factor recording before the programme, the programme uptake in the first two years and the impact of the programme on CVD risk. National coverage of the programme in one financial year was assessed using data from Primary Care Trusts (PCTs). Results: There was good recording of smoking status (86.1%) and blood pressure (82.5%), with lower BMI (59.5%) and cholesterol (47.5%) recording among Health Check eligible patients before the programme in Hammersmith and Fulham. Uptake of the Health Check was lower than the national target (75%) at 39.2% among patients with an estimated high CVD risk, but matched the national required rate at 20.0% among all remaining eligible patients. There was significant reduction in mean global CVD risk score (28.2% to 26.2%) after one year among patients with estimated high risk that had a complete Health Check. The programme uptake was higher in patients living in more deprived areas among those not at estimated high risk (adjusted odds ratio = 0.88 (0.73-106)). Mean national coverage of the programme was lower (8.1%) than anticipated (18%), with large PCT-level variation (0% to 29.8%). Coverage was significantly greater in PCTs in more deprived areas (coefficient = -0.51 (-1.88-0.00), p-value: 0.035). Conclusions: Population-wide impact of the NHS Health Check may be limited by poor uptake of the programme. This and other limitations to the programme suggest that a targeted screening approach along with population-wide strategies may be a better option for more cost-effective prevention of CVD.
SummaryObjectives To assess the completeness of cardiovascular disease(CVD) risk factor recording... more SummaryObjectives To assess the completeness of cardiovascular disease(CVD) risk factor recording and levels of risk factors in patients eligible forthe NHS Health Check.Design Cross-sectional study.Setting Twenty-eight general practices located in Hammersmith andFulham, London, UK.Participants 42,306 patients aged 40 to 74 years without existingcardiovascular disease or diabetes.Main Outcome Measures Measurement and level of CVD riskfactors: blood pressure, cholesterol, body mass index (BMI), bloodglucose and smoking status.Results There was a high recording of smoking status (86.1%) andbloodpressure(82.5%);whilstBMI,cholesterolandglucoserecordingwaslower. There was large variation in BMI, cholesterol, glucose recordingbetween practices (29.7–91.5% for BMI). Women had significantly betterrisk factor recording than men (AOR = 1.70 [1.61–1.80] for bloodpressure).Allriskfactorswerebetterrecorded inthe leastdeprivedpatientgroup (AOR = 0.79 [0.73–0.85] for blood pressure) and patients wi...
International Journal of Health Management and Tourism, 2019
The issue of maternal mortality in the developing world is still a major concern for health plann... more The issue of maternal mortality in the developing world is still a major concern for health planners and policymakers. This systematic review was done keeping in view the high maternal mortality rates in Nigeria, to identify the major direct and indirect causes and thus enable us to understand the gaps between what is and what ought to be. For this purpose, the published work was reviewed by searching the PubMed and BioMed Central databases for retrospective maternal mortality reviews and autopsies after the year 2000. Of 69 articles, 11 full-text articles were reviewed and six of them were finally included in the study. Eclampsia, pre-eclampsia, and hemorrhage were reported to be the most common direct causes of maternal mortality, all of which are preventable by simple maneuvers like regular antenatal checkups, early detection, presence of trained birth attendants to assist with the delivery, easy access to health facilities, etc. There is a need to increase the utilization of ant...
• Despite a number of limitations to our study findings, we were careful in interpreting the find... more • Despite a number of limitations to our study findings, we were careful in interpreting the findings and presented them in a balanced manner.
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