Scottish keep well health check programme an interrupted time series analysis

Geue, C. , Lewsey, J. D. , MacKay, D. F. , Antony, G., Fischbacher, C. M., Muirie, J. and McCartney, G. (2016) Scottish keep well health check programme an interrupted time series analysis. Journal of Epidemiology and Community Health, 70(9), pp. 924-929. (doi: 10.1136/jech-2015-206926) (PMID:27072868) (PMCID:PMC5013158)

Abstract

Background: Effective interventions are available to reduce cardiovascular risk. Recently, health check programmes have been implemented to target those at high risk of cardiovascular disease (CVD), but there is much debate whether these are likely to be effective at population level. This paper evaluates the impact of wave 1 of Keep Well, a Scottish health check programme, on cardiovascular outcomes. Methods: Interrupted time series analyses were employed, comparing trends in outcomes in participating and non-participating practices before and after the introduction of health checks. Health outcomes are defined as CVD mortality, incident hospitalisations and prescribing of cardiovascular drugs. Results: After accounting for secular trends and seasonal variation, coronary heart disease mortality and hospitalisations changed by 0.4% (95% CI −5.2% to 6.3%) and −1.1% (−3.4% to 1.3%) in Keep Well practices and by −0.3% (−2.7% to 2.2%) and −0.1% (−1.8% to 1.7%) in non-Keep Well practices, respectively, following the intervention. Adjusted changes in prescribing in Keep Well and non-Keep Well practices were 0.4% (−10.4% to 12.5%) and −1.5% (−9.4% to 7.2%) for statins; −2.5% (−12.3% to 8.4%) and −1.6% (−7.1% to 4.3%) for antihypertensive drugs; and −0.9% (−6.5% to 5.0%) and −2.4% (−10.1% to 6.0%) for antiplatelet drugs. Conclusions: Any impact of the Keep Well health check intervention on CVD outcomes and prescribing in Scotland was very small. Findings do not support the use of the screening approach used by current health check programmes to address CVD. We used an interrupted time series method, but evaluation methods based on randomisation are feasible and preferable and would have allowed more reliable conclusions. These should be considered more often by policymakers at an early stage in programme design when there is uncertainty regarding programme effectiveness.

• Item Type: Articles
• Additional Information: NHS Health Scotland led the national evaluation of Keep Well and this analysis was commissioned from the University of Glasgow as part of that evaluation, with funding from the Scottish Government.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Muirie, Ms Jill and Mackay, Professor Daniel and Lewsey, Professor Jim and Geue, Dr Claudia and Antony, Dr Grace
• Authors: Geue, C., Lewsey, J. D., MacKay, D. F., Antony, G., Fischbacher, C. M., Muirie, J., and McCartney, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Journal of Epidemiology and Community Health
• Journal Abbr.: J Epidemiol Community Health
• Publisher: BMJ Publishing Group
• ISSN: 0143-005X
• ISSN (Online): 1470-2738
• Published Online: 12 April 2016
• Copyright Holders: Copyright © 2016 The Authors
• First Published: First published in Journal of Epidemiology and Community Health 70(9):924-929
• Publisher Policy: Reproduced under a Creative Commons License