keep well 2013-14 - hi-net grampian · per chp is: aberdeen city 23, aberdeenshire 9, and moray 2....

Keep Well 2013-14

Analysis of

Keep Well practice data

1

Keep Well 2013-14 NHS Grampian

Keep Well 2013-14

Analysis of Keep Well practice data

Background

The following tables are based on data from the Keep Well Live2 Business Objects Universe, which is

populated by data extracted from Keep Well practices, using the SCI-DC platform. This process is

managed by NHS Tayside. The number of health checks represented in this report is 1420 (79% of

the total 1795 delivered). The difference in health check numbers is due to technical issues with SCI-

DC and also because not all practices in NHS Grampian are signed up to the Local Enhanced Service

Contract which enables data extraction. It is believed that the data set of 1420 health checks is a

representative sample of the total health checks. The number of practices represented in this data,

per CHP is: Aberdeen City 23, Aberdeenshire 9, and Moray 2. We are working with NHS Tayside to

include data from all practices participating in Keep Well so that reporting for 2013/14 is more

comprehensive.

Reach and attendance

The tables below show the number of patients invited, number attended, and % attended, by a

range of variables eg age, gender, SIMD, CHP.

Age - of the 4477 patients invited: 464 (10%) were under 40; 2204 (49%) were 40<50; 1809 (40%)

were 50-64. The table below shows that overall, 32% of patients who were invited received a health

check. The youngest age group had a higher uptake percentage compared to the other age groups;

this is a reverse of the findings of last year, and may reflect the continuing work in offering health

checks to vulnerable groups.

Invited Attended

Age No No % of

invited

Under 40 464 212 46%

40<50 2204 607 28%

50-64 1809 601 33%

Grand Total 4477 1420 32%

Gender – of the 4477 patients invited: 53% were male; 47% were female. Females were more likely to take up the offer of a health check (35% of invited females attended a health check).

Invited Attended

Gender No No % of

invited

Male 2362 676 29%

Female 2115 744 35%


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SIMD 2009 Quintile – of the 4477 patients invited, 1844 were from the most deprived quintile 1, and 1668 from quintile 2. This means that 78% were from the most deprived quintiles 1 & 2, thus illustrating that targeting has been effective. The uptake % among quintile 1 (most deprived) patients was lower than for other quintiles

Invited Attended

SIMD 2009 Quintile No No % of

invited

1 - most deprived 1844 500 27%

2 1668 573 34%

3 573 201 35%

4 124 48 39%

5 - least deprived 216 74 34%

Unassigned 52 24 46%


Carers – 93 carers were invited for a health check, and 75 attended (81%) indicating a higher than average uptake rate. However, it may be that the numbers invited are under-reported in this data set because the information on carers invited through carer health check initiatives at, for example, Aberdeen Health and Care Village, (but who did not attend) may not have been recorded in GP practice systems.

Invited Attended

Carers No No % of invited


Homeless – the majority of health checks for homeless persons are delivered in the homeless practice in Aberdeen City. The table below illustrates that the practice was able to provide health checks to the majority of patients invited.

Homeless practice Invited Attended

Age No No % of invited

Under 40 31 18 58%

40<50 15 8 53%

50-64 2 0 0%


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Ethnic Groups – 541 members of the two identified ethnic vulnerable groups were invited for a health check, and uptake was higher than the average of 32%, particularly in the South Asian group.

Invited Attended

Ethnic Vulnerable Group No No % of invited

Black Afro Caribbean 335 115 34%

South Asian 206 89 43%


Invitation Method – the table below shows that whilst invitation by ‘letter only’ was by far the most common method, it appears to be the least effective. Patients who were invited verbally or by phone were much more likely to attend a health check.

Invited Attended

Method of Invitation No No % of

invited

Letter only 3021 807 27%

Letter & verbal/phone 966 245 25%

Verbal/phone no letter 262 174 66%

Method unrecorded 228 194 85%


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Health checks – demographic data

The charts below illustrate the number of patients receiving a health check, by a range of variables

eg age, gender, SIMD. The analysis is based on 1420 health checks.

Age – compared to 2012-13, a greater proportion of health checks were delivered to the Under 40

age group (15% compared to 7%). This reflects increased delivery to vulnerable groups (core group is

40-64).

Gender – health checks were fairly evenly split between males and females. Note - from Reach

analysis, above- that more males were invited, but their uptake was lower than females.

Under 40 15%

40<50 43%

50-64 42%

Attended health check, by age group

Male 48%

Female 52%

Attended health check, by gender

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SIMD 2009 Quintiles – 77% of health checks were delivered to patients from the most deprived

quintiles (36% to Quintile 1; 41% to Quintile 2), thus illustrating that our targeting has been effective.

Compared to 2012-13 there was a higher % in the Quintile 3 category; this is because of an increased

number of Quintile 3 patients in Aberdeenshire and Moray, where the eligibility criteria extend to

Quintile 3 smokers. Quintile 5 (least deprived) health checks were patients from vulnerable groups

or those who had been specifically identified as being likely to benefit from a health check.

Employment – the majority of patients receiving a health check were in employment (61%), with

10% unemployed and 8% unfit for work.

Quintile 1 - most deprived

36%

Quintile 2 41%

Quintile 3 14%

Quintile 4 4%

Quintile 5 - least deprived

5%

Attended health check, by SIMD quintile

Employed 61%

Unemployed 10%

Unfit for work 8%

Retired 4%

Housewife/ husband

3%

Student 1%

Status not recorded

13%

Other 17%

Attended health check, by Employment Status

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Health checks – clinical data

Blood Pressure

Out of 1420 health checks, 1228 (86%) had a valid record of blood pressure. The numbers and %s

below refer to the 1228 health checks with a valid record of blood pressure. High blood pressure is

defined as systolic >140 and/or diastolic >90.

Age – older age groups had a higher percentage of patients with high blood pressure, compared to

younger age groups.

BP recorded

BP : systolic > 140 and/or diastolic >90

Age No No % of BP recorded

Under 40 175 12 7%

40<50 529 98 19%

50-64 524 134 26%


Gender – percentage of patients with high blood pressure was higher for males.

BP recorded BP : systolic > 140 and/or

diastolic >90

Gender No No % of BP recorded

Male 576 150 26%

Female 652 94 14%


SIMD 2009 Quintile – there was no specific trend or gradient in relation to deprivation.

BP recorded BP : systolic > 140 and/or

diastolic >90

SIMD 2009 Quintile No No % of BP recorded


2 496 108 22%

3 192 28 15%

4 37 10 27%


Unassigned 15 4 27%


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CHP – the percentage of patients with high blood pressure (140/90 or higher) in Moray (33%)

appears much greater than the average of 20%. However, it should be noted that the % is based on a

relatively small (58) number of patients.

BP recorded

BP : systolic > 140 and/or diastolic >90

Age No No % of BP recorded

Aberdeen City 904 174 19%

Aberdeenshire 266 51 19%

Moray 58 19 33%


Total Cholesterol

Out of 1420 health checks, 1185 (83%) had a valid record of total cholesterol. The numbers and %s

below refer to the 1185 health checks with a valid record of cholesterol.

Age – the percentage of patients with high cholesterol increases with age.

Total cholesterol recorded

Cholesterol >5

Age No No % of total

Under 40 163 56 34%

40<50 519 270 52%

50-64 503 311 62%


Gender – the percentage of males and females with high cholesterol (>5) was similar.


Cholesterol >5

Gender No No % of total

Male 559 292 52%

Female 626 345 55%


8


SIMD 2009 Quintile –the percentages with high cholesterol (>5) were fairly similar across the

quintiles.


Cholesterol >5

SIMD 2009 Quintile No No % of total


2 482 266 55%

3 165 88 53%

4 38 20 53%


Unassigned 17 9 53%


CHP – it appears that Aberdeen City had a lower percentage of patients with high cholesterol (>5)

when compared to the other two CHPs.


Cholesterol >5




Moray 61 39 64%


ASSIGN CVD Risk Score

A key component of the Keep Well health check is the ASSIGN CVD risk score.

Out of 1420 health checks, 843 (59%) had an ASSIGN score recorded. The numbers and %s below

refer to the 843 health checks with a valid record of ASSIGN score. It might be argued that this data

may not represent the true situation regarding the ASSIGN scores in the Keep Well population and

therefore some analysis was carried out to check that argument. A separate data analysis was

carried out; including only those practices where the percentage of health checks with an ASSIGN

score recorded was high. This analysis showed similar findings to those below, therefore we are

assured that this data is robust.

Potentially, there are two key reasons why recording of ASSIGN score has been so low. One is that it

cannot be recorded at the health check unless the blood test results are available. The other is that it

may not be widely understood that the risk calculator that exists as part of Vision does not

automatically record the score in the patient journal.

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Age – as would be expected, CVD risk >= 20% increased with age. 2% of 40<50 year olds had a high

CVD risk, compared to 19% among the over 50s.

Risk score calculated

Score >= 20%

Age No No % of calculated

Under 40 92 1 1%

40<50 352 7 2%

50-64 399 74 19%


Gender – males were more likely than females to have a high CVD risk.


Score >= 20%

Gender No No % of calculated

Male 402 49 12%

Female 441 33 7%


SIMD 2009 Quintiles – the numbers per quintile were fairly low, therefore the percentages in the

table below may not be significantly different.


Score >= 20%

SIMD 2009 Quintile No No % of calculated


2 347 35 10%

3 147 16 11%

4 19 1 5%


Unassigned 14 4 29%


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CHP – analysis by CHP suggests that high ASSIGN risk scores were more common among health

checks in Aberdeenshire and Moray, compared to Aberdeen City. However, some care should be

taken in interpreting this data, as the numbers of health checks with a risk score were fairly small in

Aberdeenshire and particularly Moray.

It should also be noted that the eligibility criteria used in Shire and Moray specifically targets

smokers.


Score >= 20%

Age No No % of calculated



Moray 52 5 10%


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Health checks – lifestyle data

Smoking

Note that this data is influenced by the fact that in Aberdeenshire and Moray, smoking is used as

one of the eligibility criteria.

Out of 1420 health checks, 1280 (90%) had a current smoking status. The numbers and %s below

refer to the 1280 health checks with a current smoking status.

Age – patients in the youngest age group were the least likely to be smokers (34% compared to the

overall % of 40%).

Total: Smoking status

recorded

Non smoker

Ex smoker

Smoker

Age No No No No % of total

Under 40 188 106 18 64 34%

40<50 552 198 120 234 42%

50-64 540 173 155 212 39%

Grand Total 1280 477 293 510 40%

Gender – males and females were equally likely to be smokers.


recorded

Non smoker

Ex smoker

Smoker

Gender No No No No % of total

Male 603 214 145 244 40%

Female 677 263 148 266 39%

Grand Total 1280 477 293 510 40%

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SIMD 2009 quintile and CHP – the data below is heavily influenced by the fact that in Shire and

Moray, quintile and smoking status are used as eligibility criteria.


recorded

Non smoker

Ex smoker

Smoker

SIMD 2009 Quintile No No No No % of total

1 - most deprived 460 172 119 169 37%

2 513 184 115 214 42%

3 177 43 35 99 56%

4 44 25 10 9 20%

5 - least deprived 67 44 10 13 19%

Unassigned 19 9 4 6 32%

Grand Total 1280 477 293 510 40%


recorded

Non smoker

Ex smoker

Smoker

Age No No No No % of total

Aberdeen City 988 453 229 306 31%

Aberdeenshire 237 20 53 164 73%

Moray 55 4 11 40 69%

Grand Total 1280 477 293 510 40%

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Body Mass Index (BMI)

Out of 1420 health checks, 1279 (90%) had a current BMI. The numbers and %s below refer to the

1279 health checks with a current BMI.

Age – the percentage of patients with a BMI of 25+ increased with age.

BMI calculated

BMI 25+

Age No No % of BMI

calculated

Under 40 193 123 64%

40<50 541 363 67%

50-64 545 380 70%


Gender – the percentage of patients with a BMI of 25+ was similar for males and females.

BMI calculated

BMI 25+

Gender No No % of BMI

calculated

Male 605 417 69%

Female 674 449 67%


SIMD 2009 quintile – given that there were low numbers of patients in the less deprived quintiles,

there does not appear to be a significant difference in the percentage with BMI 25+ across the

quintiles.

BMI calculated

BMI 25+

SIMD 2009 Quintile No No % of BMI

calculated


2 515 323 63%

3 182 121 66%

4 43 35 81%


Unassigned 19 13 68%


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CHP – the percentage of patients with a BMI of 25+ appears lower for Moray, although it should be

noted that this is based on low numbers.

BMI calculated

BMI 25+

Age No No % of BMI

calculated



Moray 52 31 60%


Exercise

Out of 1420 health checks, 1205 (85%) had a current exercise/activity status. The numbers and %s

below refer to the 1205 health checks with a current exercise/activity status.

Current guidance for adequate activity levels is ‘at least 30 minutes of moderate activity on at least 5

days a week’. Around one in ten patients stated that they achieved this level of activity; however, it

is possible that this Read code had been under-reported or overlooked. Therefore, the tables below

group the Read codes for ‘Enjoys moderate exercise’, ‘Enjoys heavy exercise’ and/or ‘at least 30

minutes of moderate activity on at least 5 days a week’ into the statement ‘meets current

guidelines’.

Age – As might be expected, activity levels were highest in the youngest age group.

Total: activity level recorded

‘Meets’ current guidance


Under 40 187 95 51%

40<50 511 210 41%

50-64 507 175 35%


Gender – males were more likely to meet current guidelines than females.



Gender No No % of total

Male 577 255 44%

Female 628 225 36%


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SIMD 2009 quintiles – activity levels across the quintiles were broadly similar.



SIMD 2009 Quintile No No % of total


2 500 197 39%

3 179 76 42%

4 43 14 33%


Unassigned 20 7 35%


CHP – it appears that Aberdeen City patients were more likely to meet current guidance on activity.






Moray 57 14 25%


Jackie Fleming

Keep Well Information Analyst

[email protected]

October 2014

mailto:[email protected]

keep well 2013-14 - hi-net grampian · per chp is: aberdeen city 23, aberdeenshire 9, and moray 2....

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