Smoking, obesity, alcohol intake, and physical inactivity bring forward the onset of chronic disease and premature death by about 6 years in the UK. One way the NHS addresses this is through preventive healthcare. This includes supporting people to change their behaviour. This support has been shown to be effective and cost-saving. However, the rate of intervention by healthcare professionals is low. The shift to remote (usually telephone) consulting may have reduced opportunities for this. Initial research shows that telephone consultations are more transactional, with less discussion of ‘other’ health topics, including preventive care.
This study will firstly develop a system to categorise whether consultations occurred remotely or face to face within the CPRD database. Secondly, we will assess the rate of preventive care using anonymised general practice records. We will explore whether the type of consultation (face-to-face, telephone, video or email) affects preventive care delivery in UK primary care. This will be analysed for the whole adult population, and then by subgroups, including people from different age groups, ethnic groups or sex. This will help healthcare professionals and policy makers understand where prevention is working well and where it can be improved for the whole population.
Aim: To quantify the rate of occurrence of brief interventions (BI) for smoking, obesity, excess alcohol, and physical activity by consultation mode in English primary care. Understanding if BIs are being delivered across all consultation modes is the first step to optimise implementation.
Objective 1: To develop a consultation categorisation system in CPRD Aurum.
Objective 2: 1 To examine the likelihood of a BI occurring according to consultation mode: a) face to face vs remote (modes combined) b) face to face vs i. telephone and video and ii. text and email. 2 To examine whether occurrence of BI delivery differs by age, ethnicity, gender or IMD i. overall ii. by consultation mode.
Study population
Adults (18+) registered with a general practice in England from 1/1/2019 – 31/12/2022.
Primary exposures and outcomes
1: Exposure: Primary care consultation. Outcome: Consultation mode
2: Exposure: Consultation mode. Outcome: Advice or support (BIs).
Data sources
CPRD Aurum, ethnicity and IMD data
Study design and methods
1: Descriptive analysis (% agreement) of new consultation categorisation system compared to EMIS consultation categorisation with narrative synthesis of discrepancies.
2: An open cohort study using logistic regression analysis to calculate the odds of a brief intervention occurring face to face vs remotely
Public health benefit
Half of all smokers will die prematurely and 52% of cancer deaths are attributable to smoking. Health systems can address this is through preventive healthcare including BIs. Systematic reviews of randomised trials show that BIs are:
• effective and cost-saving for smoking cessation
• effective and cost-effective for reducing hazardous drinking and weight loss
• effective and may be cost-effective for physical inactivity
This study will quantify whether there is a difference in implementation of BI between consultation modes and population subgroups. If present, targeted strategies to increase implementation can be developed.
Objective 1: The number and proportion of consultations of different modes conducted every month during 2019 and the most recent year for which there is complete data available. These will be compared to EMIS consultation mode codes (consmedcodeid and consourceid) and percentage agreement between the systems calculated. Lists of the most frequent discrepancies will be reviewed and narratively analysed.
Objective 2: Outcomes of interest include the offer of advice, or referral for further support for the four main behavioural risk factors.
1. Smoking – a. smoking cessation advice given; b. referral to smoking cessation services.
2. Obesity – a. weight management advice given; b. referral to further weight management support.
3. Problem drinking – a. advice about alcohol intake; b. referral to alcohol support service.
4. Physical inactivity – a. advice about physical activity; b. referral to exercise on prescription or similar service.
Paul Aveyard - Chief Investigator - University of Oxford
Laura Heath - Corresponding Applicant - University of Oxford
Brian Nicholson - Collaborator - University of Oxford
Clare Bankhead - Collaborator - University of Oxford
Cynthia Wright Drakesmith - Collaborator - University of Oxford
Joseph Wherton - Collaborator - University of Oxford
Katja Maurer - Collaborator - University of Oxford
Margaret Smith - Collaborator - University of Oxford
Susannah Fleming - Collaborator - University of Oxford
Paul Aveyard - Collaborator - University of Oxford
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record