Prevalence of risk factors for heart disease in OXCHECK trial: Implications for screening in primary care
Coulter A., Fowler G., Jones L., Lawrence M., Mant D., Muir J., Neil A., Roe L., Rusted N., Schofield T., Thorogood M., Yudkin P.
Objective - To describe the outcome of offering health checks systematically to a general practice adult population, in terms of age and sex specific prevlance of risk factors, follow up workload, and selective screening of cholesterol concentration. Design - Descriptive analysis of data obtained by postal questionnaire and by personal interview and clinical examination by a trained nurse. Subjects - 2205 patients aged 35-64 who attended for a health check in 1989-90 from an invited random sample of 2777 patients from five urban general practices in Bedfordshire. Results - Overall, almost three quarters of patients (78% of men, 68% of women) needed specific advice or follow up. Smoking, a high fat diet, and being overweight (body mass index ≥25 kg/m2) were common characteristics exhibited by 35%, 31%, and 55% respectively of men and 24%, 18%, and 48% of women. The total cholesterol concentration was ≥6.5 mmol/l in 37% of patients and ≥8mmol/l in 8%. In terms of workload 13% needed dietary advice only, 15% needed only follow up of hyperlipidaemia or hypertension, and 9% needed advice on smoking only. A further 35% needed follow up for a combination of risk factors. The proporation of patients in whom cholesterol concentration would be measured if a selective screening policy were adopted would vary from 29% to 71%, according to different criteria, but (particularly in men) no combination would be much better than random testing as a means to detect patients with a total cholesterol concentration ≥8 mmol/l. Conclusions - If the entire adult popualtion of a practice is offered health checks systematically the acceptance rate is lower and the follow up workload higher than previously understood. The resource implications depend on the age and sex of patients screened and the selective criteria adopted for cholesterol measurement. Health checks are only the beginning of a successful preventive programme - the challenge is to provide effective intervention and follow up.