EFFECTIVENESS OF HEALTH CHECKS CONDUCTED BY NURSES IN PRIMARY-CARE - FINAL RESULTS OF THE OXCHECK STUDY

Objective-To determine the effectiveness of health checks, performed b y nurses in primary care, in reducing risk factors for cardiovascular disease and cancer. Design-Randomised controlled trial. Setting-Five u rban general practices in Bedfordshire. Subjects-2205 men and women wh o were randomly allocated a first health check in 1989-90 and a re-exa mination in 1992-3 (the intervention group); 1916 men and women who we re randomly allocated an initial health check in 1992-3 (the control g roup). All subjects were aged 35-64 at recruitment in 1989. Main outco me measures-Serum total cholesterol concentration, blood pressure, bod y mass index, and smoking prevalence (with biochemical validation of c essation); self reported dietary, exercise, and alcohol habits. Result s-Mean serum total cholesterol was 3.1% lower in the intervention, gro up than controls (difference 0.19 mmol/l (95% confidence interval 0.12 to 0.26)); in women it was 4.5% lower (P<0.0001) and in men 1.6% (P<0 .05), a significant difference between the sexes (P<0.01). Self report ed saturated fat intake was also significantly lower in the interventi on group. Systolic and diastolic blood pressures and body mass index w ere respectively 1.9%, 1.9%, and 1.4% lower in the intervention group (P<0.005 in all cases). There was a 3.9% (2.4 to 5.3) difference in th e percentage of subjects with a cholesterol concentration greater than or equal to 8 mmol/l, but no significant differences in the number wi th diastolic blood pressure greater than or equal to 100 mmHg or body mass index greater than or equal to 30 kg/m(3). There was no significa nt difference between the two groups in prevalence of smoking or exces sive alcohol use. Annual rechecks were no more effective than a single recheck at three years, but health checks led to a significant increa se in visits to the nurse according to patients' degree of cardiovascu lar risk. Conclusions-The benefits of health checks were sustained ove r three years. The main effects were to promote dietary change and red uce cholesterol concentrations; small differences in blood pressure ma y have been attributable to accommodation to measurement. The benefits of systematic health promotion in primary care are real, but must be weighed against the costs in relation to other priorities.