Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 25;10(9):e037790.
doi: 10.1136/bmjopen-2020-037790.

Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators

Christopher J Gidlow  1 , Naomi J Ellis  2 , Lisa Cowap  3 , Victoria A Riley  2 , Diane Crone  4 , Elizabeth Cottrell  5 , Sarah Grogan  6 , Ruth Chambers  7 , David Clark-Carter  3
Affiliations

Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators

Christopher J Gidlow et al. BMJ Open. .

Abstract

Objectives: Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators.

Design: RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation.

Setting and participants: Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity.

Methods: Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management.

Results: 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17).

Conclusions: There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences.

Trial registration number: ISRCTN10443908.

Keywords: coronary heart disease; preventive medicine; primary care.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Duration of NHSHC consultation by CVD risk calculator group. HC, Health Check.
Figure 2
Figure 2
Mean percentage of total NHSHC time with speaking by practitioner or patient. NHSHC, NHS Health Check.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Wilkins E, Wickramasinghe K. European cardiovascular disease statistics 2017 edition. Brussels: European Heart Network, 2017.
    1. Bhatnagar P, Wickramasinghe K, Wilkins E, et al. . Trends in the epidemiology of cardiovascular disease in the UK. Heart 2016;102:1945–52. 10.1136/heartjnl-2016-309573 - DOI - PMC - PubMed
    1. National Health Service The NHS long term plan. London: NHS, 2019.
    1. Department of Health and Social Care Advancing our health: prevention in the 2020s – consultation document. London: HMSO, 2019.
    1. Department of Health Putting prevention first. NHS Health Check: vascular risk assessment and management best practice guidance. London: DH, 2009.

Publication types

Associated data