Better Value Health Checks: A Practical Guide

289 Pages·2018·2.588 MB·English

by  Nick Summerton

Better Value
Health Checks
A P R A C T I C A L G U I D E
Better Value
Health Checks
A P R A C T I C A L G U I D E
Nick Summerton
Better Value
Health Checks
A P R A C T I C A L G U I D E
Nick Summerton
CRC Press
Taylor & Francis Group
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Contents
Preface xiii
Author xv
Acknowledgements xvii
List of abbreviations xix
1 Introduction 1
2 Health checks: Challenges and opportunities 5
2.1 What are the issues with health checks? 5
2.1.1 Purposes 6
2.1.2 Components 7
2.1.2.1 Information 8
2.1.2.2 Eligibility 11
2.1.3 Outputs 13
2.2 Do health checks work? 16
2.2.1 Reviews 18
2.2.1.1 Definition 19
2.2.1.2 The nature of the evidence 19
2.2.2 Individual evaluations 20
2.2.2.1 OXCHECK 20
2.2.2.2 NHS Health Check 20
2.2.2.3 Ebeltoft 22
2.2.3 The clinical examination 26
2.3 Is there a demand for health checks? 28
2.4 How might the quality of health checks be improved? 31
References 32
3 Better value health checks: Key elements 37
3.1 Definition of a better value health check 37
3.2 Architecture of a better value health check 39
3.2.1 Assessing needs 39
3.2.2 Clarifying purposes 40
3.2.3 Determining outcomes 40
3.2.4 Considering costs 44
3.2.5 Choosing measures wisely 47
3.2.6 Adopting a risk-oriented strategy 51
v
vi Contents
3.3 Operational elements of a better value health check 54
3.3.1 Enhancing value before undertaking the health check 54
3.3.1.1 Taking stock 54
3.3.1.2 Considering the information requirements 55
3.3.1.3 Offering a balanced package 57
3.3.1.4 Enabling accessibility 59
3.3.2 Enhancing the value of the health check 62
3.3.2.1 Standard operating procedures 62
3.3.2.2 Resource management 62
3.3.2.3 Quality assurance 63
3.3.3 Enhancing value after the health check 64
3.3.3.1 Ensuring effectiveness 64
3.3.3.2 Reviewing safety and quality 65
3.3.3.3 Boosting impacts on individuals 65
3.3.3.4 Augmenting impacts for groups
(e.g. organisations) 71
3.3.3.5 Trending 71
References 74
4 Cardiovascular health 77
Key recommendations 77
4.1 Overview 77
4.2 Atherosclerotic cardiovascular disease 78
4.2.1 Importance 78
4.2.2 Prevention 78
4.2.3 Earlier recognition 80
4.2.3.1 Baseline clinical assessment 80
4.2.3.2 Baseline investigations 82
4.2.3.3 Risk scoring 83
4.2.3.4 Refining risk 84
4.3 Atrial fibrillation 85
4.3.1 Importance 85
4.3.2 Prevention 85
4.3.3 Earlier recognition 88
4.4 Abdominal aortic aneurysms 89
4.4.1 Importance 89
4.4.2 Prevention 89
4.4.3 Earlier recognition 89
Further reading 91
5 Lung health 95
Key recommendations 95
5.1 Overview 95
5.2 Chronic obstructive pulmonary disease 96
5.2.1 Importance 96
5.2.2 Prevention 96
5.2.3 Earlier recognition 97
5.2.3.1 Risk assessment 97
Contents vii
5.2.3.2 Case-finding 97
5.2.3.3 Alpha-1 antitrypsin deficiency screening 99
5.2.3.4 Identifying co-morbidities 100
5.3 Tuberculosis 100
5.3.1 Importance 100
5.3.2 Prevention 100
5.3.3 Earlier recognition 101
5.3.3.1 Risk assessment 101
5.3.3.2 Active TB case-finding 101
5.3.3.3 Latent TB screening 103
5.4 Lung cancer 104
5.4.1 Importance 104
5.4.2 Prevention 105
5.4.3 Earlier recognition 105
5.4.3.1 Risk assessment 105
5.4.3.2 Symptoms 105
5.4.3.3 Screening 106
Further reading 107
6 Musculoskeletal health 111
Key recommendations 111
6.1 Overview 111
6.2 Low back pain 112
6.2.1 Importance 112
6.2.2 Prevention 112
6.2.3 Earlier recognition 113
6.2.3.1 Red flags 113
6.2.3.2 Yellow flags 114
6.3 Osteoporosis 115
6.3.1 Importance 115
6.3.2 Prevention 116
6.3.3 Earlier recognition 117
6.3.3.1 Risk assessment 117
6.3.3.2 Screening 117
6.4 Vitamin D 120
6.4.1 Importance 120
6.4.2 Prevention 121
6.4.3 Earlier recognition 121
6.5 Rheumatoid arthritis 122
6.5.1 Importance 122
6.5.2 Prevention 122
6.5.3 Earlier recognition 122
6.6 Gout 123
6.6.1 Importance 123
6.6.2 Prevention 124
6.6.3 Earlier recognition 124
Further reading 124
viii Contents
7 Gastrointestinal health 129
Key recommendations 129
7.1 Overview 129
7.2 Colorectal cancer 130
7.2.1 Importance 130
7.2.2 Prevention 131
7.2.3 Earlier recognition 131
7.2.3.1 Risk assessment 131
7.2.3.2 Screening 132
7.3 Gastric cancer 134
7.3.1 Importance 134
7.3.2 Prevention 134
7.3.3 Earlier recognition 135
7.3.3.1 Risk assessment 135
7.3.3.2 Screening 135
7.4 Coeliac disease 136
7.4.1 Importance 136
7.4.2 Prevention 137
7.4.3 Earlier recognition 137
7.4.3.1 Symptoms for case-finding 137
7.4.3.2 Risk assessment for case-finding 137
Further reading 138
8 Liver health 141
Key recommendations 141
8.1 Overview 141
8.2 Hepatitis B 144
8.2.1 Importance 144
8.2.2 Prevention 144
8.2.3 Earlier recognition 145
8.3 Hepatitis C 146
8.3.1 Importance 146
8.3.2 Prevention 147
8.3.3 Earlier recognition 148
8.4 Hereditary haemochromatosis 148
8.4.1 Importance 148
8.4.2 Prevention 149
8.4.3 Earlier recognition 149
8.5 Liver fibrosis 151
8.5.1 Importance 151
8.5.2 Prevention 151
8.5.3 Earlier recognition 152
8.6 Hepatocellular carcinoma 155
8.6.1 Importance 155
8.6.2 Prevention 155
8.6.3 Earlier recognition 155
Further reading 156
Contents ix
9 Endocrine and metabolic health 159
Key recommendations 159
9.1 Overview 159
9.2 Type 2 diabetes 160
9.2.1 Importance 160
9.2.2 Prevention 161
9.2.3 Earlier recognition 161
9.2.3.1 Risk assessment 161
9.2.3.2 Blood testing 163
9.3 Thyroid dysfunction 164
9.3.1 Importance 164
9.3.2 Prevention 165
9.3.3 Earlier recognition 165
9.3.3.1 Symptoms 165
9.3.3.2 Case-finding 165
9.3.3.3 Blood testing 166
Further reading 166
10 Epithelial health 169
Key recommendations 169
10.1 Overview 169
10.2 Skin cancer 170
10.2.1 Importance 170
10.2.2 Prevention 170
10.2.3 Earlier recognition 171
10.2.3.1 Risk assessment 171
10.2.3.2 Visual inspection 171
10.2.3.3 Melanoma screening and case-finding 173
Further reading 174
11 Mental health 175
Key recommendations 175
11.1 Overview 175
11.2 Depression 176
11.2.1 Importance 176
11.2.2 Prevention 177
11.2.3 Earlier recognition 180
11.3 Anxiety disorders 181
11.3.1 Importance 181
11.3.2 Prevention 182
11.3.3 Earlier recognition 182
11.4 Eating disorders 183
11.4.1 Importance 183
11.4.2 Prevention 183
11.4.3 Earlier recognition 184
Further reading 185
12 Men’s health 187
Key recommendations 187