The British journal of general practice : the journal of the Royal College of General Practitioners
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Randomized Controlled Trial
Increasing uptake of NHS Health Checks: an RCT using GP computer prompts.
Public Health England wants to increase the uptake of the NHS Health Check (NHSHC), a cardiovascular disease prevention programme. Most invitations are sent by letter, but opportunistic invitations may be issued and verbal invitations have a higher rate of uptake. Prompting staff to issue opportunistic invitations might increase uptake. ⋯ Prompts on computer systems in general practice were effective at improving the uptake of the NHSHC, especially for males and younger patients.
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Review templates are commonly used in long-term condition (LTC) consultations to standardise care for patients and promote consistent data recording. However, templates may affect interactions during the review and, potentially, inhibit patient-centred care. ⋯ Future research should evaluate health, as well as process, outcomes. The potential benefits of templates in improving documentation should be balanced against concerns that 'tick boxes' may override patient agendas, unless templates are designed to promote patient-centred care.
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Scotland abolished the Quality and Outcomes Framework (QOF) in April 2016, before implementing a new Scottish GP contract in April 2018. Since 2016, groups of practices (GP clusters) have been incentivised to meet regularly to plan and organise quality improvement (QI) as part of this new direction in primary care policy. ⋯ Cluster development would benefit from more consistent training and support for cluster leads in small-group facilitation, leadership, and QI expertise, and data analytics access and capacity. While GP clusters are up and running, their impact is likely to be limited without further investment in developing capacity in these areas.
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Observational Study
FORM-2C (Frequency of Renal Monitoring - Creatinine and Cystatin C): An observational cohort study of primary care patients with reduced eGFR.
Monitoring is the mainstay of chronic kidney disease management in primary care; however, there is little evidence about the best way to do this. ⋯ In the primary analysis neither eGFR estimated from serum creatinine nor from serum cystatin C predicted future change in kidney function, partly due to small changes during 2 years. In some secondary analyses there was a suggestion that serum cystatin C was a more useful biomarker to estimate eGFR, especially in those with a baseline eGFR <60 ml/min/1.73 m2.
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Observational Study
NHS Health Checks: Equity and outcomes 2009-17: An observational study.
The NHS Health Check cardiovascular prevention programme is now 10 years old. ⋯ Uptake of NHS Health Checks remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension, and CKD, and to receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, <10% were treated. Policy reviews should consider a targeted approach prioritising those at highest CVD risk for face-to-face contact and consider other options for those at lower CVD risk.