BMJ 1994;308:308-312 (29 January)

General practice

Effectiveness of health checks conducted by nurses in primary care: results of the OXCHECK study after one year

J Muir, D Mant, L Jones, P Yudkin,  on behalf of the Imperial Cancer Research Fund OXCHECK Study Group

University of Oxford, Department of Public Health and Primary Care, Radcliffe Infirmary, Oxford OX2 6HE.

Abstract

Objective : To assess the effectiveness of health checks by nurses in reducing risk factors for cardiovascular disease in patients from general practice.
Design : Randomised controlled trial.
Setting : Five urban general practices in Bedfordshire.
Subjects : 2136 patients receiving an initial health check in 1989-91 and scheduled to be re-examined one year later in 1990-2 (intervention group); 3988 patients receiving an initial health check in 1990-2 (control group). All patients were aged 35-64 years at recruitment in 1989.
Main outcome measures : Serum total cholesterol concentration, blood pressure, body mass index, confirmed smoking cessation.
Results : Mean serum total cholesterol was 2.3% lower in the intervention group than in the controls (difference 0.14 mmol/l (95% confidence interval 0.08 to 0.20)); the difference was greater in women (3.2%, P<0.0001) than men (1.0%, P=0.18). There was no significant difference in smoking prevalence, quit rates, or body mass index. Systolic and diastolic blood pressure were 2.5% and 2.4% lower respectively in the intervention group. The proportion of patients with diastolic blood pressure >=100 mm Hg was 2.6% (55/2131) in the intervention group and 3.4% (137/3987) in the controls (difference 0.9% (0.0 to 1.7); the proportion with total cholesterol concentration >=8 mmol/l 4.8% (100/2068) and 7.6% (295/3905) (difference 2.7% (1.5 to 4.0)); and that with body mass index >=30 12.4% (264/2125) and 14.0% (559/3984) (difference 1.6% (-0.2 to 3.4)).
Conclusion : General health checks by nurses are ineffective in helping smokers to stop smoking, but they help patients to modify their diet and total cholesterol concentration. The public health importance of this dietary change depends on whether it is sustained.

Practice implications

  • Practice implications

  • General health checks by nurses are ineffective in helping smokers to stop smoking

  • Some studies have shown that advice to stop smoking from general practitioners is effective and that the rates of stopping can be increased by systematic follow up by nurses

  • This study found that health checks are effective in helping patients to lower their cholesterol concentration but the overall effect was small, particularly in men

  • The public health benefit of reducing cholesterol concentration depends on whether the effect is sustained

  • The involvement of nurses is likely to improve the management of patients with hypertension and high cholesterol concentration


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