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Be SMART: examining the experience of implementing the NHS Health Check in UK primary care

机译：精打细算：探讨在英国初级保健中实施NHS健康检查的经验

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Background The NHS Health Check was designed by UK Department of Health to address increased prevalence of cardiovascular disease by identifying risk levels and facilitating behaviour change. It constituted biomedical testing, personalised advice and lifestyle support. The objective of the study was to explore Health Care Professionals’ (HCPs) and patients’ experiences of delivering and receiving the NHS Health Check in an inner-city region of England. Methods Patients and HCPs in primary care were interviewed using semi-structured schedules. Data were analysed using Thematic Analysis. Results Four themes were identified. Firstly, Health Check as a test of ‘roadworthiness’ for people. The roadworthiness metaphor resonated with some patients but it signified a passive stance toward illness. Some patients described the check as useful in the theme, Health check as revelatory. HCPs found visual aids demonstrating levels of salt/fat/sugar in everyday foods and a ‘traffic light’ tape measure helpful in communicating such ‘revelations’ with patients. Being SMART and following the protocolrevealed that few HCPs used SMART goals and few patients spoke of them. HCPs require training to understand their rationale compared with traditional advice-giving. The need for further follow-up revealed disparity in follow-ups and patients were not systematically monitored over time. Conclusions HCPs’ training needs to include the use and evidence of the effectiveness of SMART goals in changing health behaviours. The significance of fidelity to protocol needs to be communicated to HCPs and commissioners to ensure consistency. Monitoring and measurement of follow-up, e.g., tracking of referrals, need to be resourced to provide evidence of the success of the NHS Health Check in terms of healthier lifestyles and reduced CVD risk.
机译：背景NHS健康检查由英国卫生部设计，旨在通过识别风险水平和促进行为改变来解决心血管疾病的增加。它构成了生物医学测试，个性化建议和生活方式支持。这项研究的目的是探索医疗保健专业人员（HCP）以及患者在英格兰市中心地区提供和接受NHS健康检查的经验。方法采用半结构化的时间表对接受初级保健的患者和HCP进行访谈。使用主题分析对数据进行分析。结果确定了四个主题。首先，健康检查是对人们的“适用性”的测试。耐行性比喻在一些患者中引起共鸣，但它表示对疾病的消极态度。一些患者将检查描述为主题，将健康检查作为启示。 HCP发现视觉辅助工具可以证明日常食品中的盐/脂肪/糖含量，并且使用“交通信号灯”卷尺有助于与患者交流此类“启示”。成为SMART并遵循该协议表明，很少有HCP使用SMART目标，很少有患者谈到这些目标。与传统的建议相比，HCP需要进行培训以了解其基本原理。进一步随访的必要性表明随访之间存在差异，并且未随时间对患者进行系统地监测。结论HCP的培训需要包括SMART目标在改变健康行为方面的使用和证据。保真度对协议的重要性需要传达给HCP和专员，以确保一致性。需要提供监视和跟踪随访的方法，例如跟踪转诊情况，以从健康的生活方式和降低的CVD风险方面提供NHS健康检查成功的证据。

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