Is alcohol and physical activity appropriately discussed with patients in preventive care?
Cardiovascular disease (CVD) is made up of conditions affecting the heart and blood vessels, including heart disease and stroke. Over 25% of deaths recorded each year in the UK are from cardiovascular disease, yet peoples’ risk can be reduced through making changes to their health behaviour (e.g., by stopping smoking, improving diet).
In 2009, the NHS Health Check programme was launched by the Department of Health to reduce cardiovascular disease in England. This national programme invites those not known to have a chronic condition aged 40-74 to have their cardiovascular disease risk assessed every five years. The Health Check is delivered face-to-face, usually by a practice nurse or healthcare assistant following an invitation from the GP.
During the NHS Health Check, practitioners should measure physical activity using the General Practitioner Physical Activity Questionnaire (GPPAQ). The GPPAQ asks questions about how active people are at home, at work, for recreation and walking.
Alcohol is often measured using the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) questionnaire – three questions about how often a person drinks, how much is consumed and how often six (female) or eight (male) units are consumed on a single occasion. If this questionnaire highlights a potential issue, the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) questionnaire should be completed, which involves another seven questions to understand if is a person is excessively drinking (e.g., How many units of alcohol do you drink on a typical day when you are drinking? How often during the last year have you been unable to remember what happened the night before because you had been drinking?).
Yet, national data for the programme, found that physical activity and alcohol was recorded in just 64.5% and 38.3% of GP patient records, respectively.
Data from our recent study of 130 video-recorded NHS Health Checks, found there were differences between how practitioners recorded alcohol intake in the patients’ medical record and how they discussed it with patients during the consultation. We observed from the video-recorded Health Checks that practitioners completed or partly completed the full alcohol assessment questionnaire (AUDIT) in less than half of patients who were eligible. Practitioners were more consistent when assessing a patient’s physical activity during the Health Check, but sometimes did not ask about physical activity levels at work.
Overall, discrepancies in the use of recommended questionnaires for assessing alcohol and physical activity in the NHS Health Check programme suggests that some practitioners are not following recommended national guidance. When practitioners did not ask patients certain questions about their alcohol intake, they missed opportunities to discuss alcohol further, particularly for those who suggested their alcohol intake was high (>14 units per week). Having these conversations is important so that practitioners can support people to live healthier lives by reducing their cardiovascular disease risk. Interviews with practitioners who deliver NHS Health Checks to patients may help us to understand why the recommended questionnaires are not being used effectively in preventive care and to identify ways to improve the how practitioners talk to people about behaviours which can be important for reducing CVD risk.
If you would like to read more about the research, you can gain full access to our research article here.
Vicky is happy to talk about her research and can be contacted by email; Victoria.Riley@staffs.ac.uk and Twitter; @DRVictoriaRiley
