Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators

Objectives Quantitatively examine the content of National
Health Service Health Check (NHSHC), patient–practitioner
communication balance and differences when using
QRISK2 versus JBS3 cardiovascular disease (CVD) risk
calculators.
Design RIsk COmmunication in NHSHC was a qualitative
study with quantitative process evaluation, comparing
NHSHC using QRISK2 or JBS3. We present data from the
quantitative process evaluation.
Setting and participants Twelve general practices in
the West Midlands (England) conducted NHSHC using
JBS3 or QRISK2 (6/group). Patients were eligible for
NHSHC based on national criteria (aged 40–74, no existing
cardiovascular-related
diagnoses, not taking statins).
Recruitment was stratified by patients’ age, gender and
ethnicity.
Methods Video recordings of NHSHC were coded,
second-by-
second,
to quantify who was speaking
and what was being discussed. Outcomes included
consultation duration, practitioner verbal dominance (ratio
of practitioner:patient speaking time (pr:pt ratio)) and
proportion of time discussing CVD risk, risk factors and
risk management.
Results 173 video-recorded
NHSHC were analysed (73
QRISK, 100 JBS3). The sample was 51% women, 83%
white British, with approximately equal proportions across
age groups. NHSHC duration varied greatly (6.8–38.0 min).
Most (60%) lasted less than 20 min. On average, CVD
risk was discussed for less than 2 min (9.06%±4.30% of
consultation time). There were indications that, compared
with NHSHC using JBS3, those with QRISK2 involved less
CVD risk discussion (JBS3 M=10.24%, CI: 8.01–12.48 vs
QRISK2 M=7.44%, CI: 5.29–9.58) and were more verbally
dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI:
2.44–3.97 vs QRISK2=2.35%, CI: 1.89–2.81). The largest
proportion of NHSHC time was spent discussing causal
risk factors (M=37.54%, CI: 32.92–42.17).
Conclusions There was wide variation in NHSHC
duration. Many were short and practitioner-dominated,
with little time discussing CVD risk. JBS3 appears to
extend CVD risk discussion and patient contribution.
Qualitative examination of how it is used is necessary to
fully understand the potential benefits of these differences