Registration health checks: inverse care in the inner city?

BACKGROUND Attendance at health checks of patients already registered with a general practitioner is known to be poor, with those in need least likely to attend. Little is known of the efficacy of such checks for newly registered patients. AIM This study set out to determine the characteristics of attenders and non-attenders at health checks for patients registering with a general practitioner in east London, and the effect of health checks on motivation to change unhealthy lifestyles. METHOD A questionnaire analysis was carried out of patients aged 16 years and over at registration and after a health check in seven east London training practices. Questionnaires asked about personal background and lifestyle including smoking status, alcohol intake, diet, weight, exercise, cervical smear uptake, and motivation to change unhealthy aspects of lifestyle. RESULTS Questionnaires were offered to 356 patients registering with the practices, of whom 101 declined or returned inadequate data. Of the remaining 255 patients, 118 (46%) attended a health check with 113 completing a second questionnaire after the check. Non-attenders were significantly more likely than attenders to be of lower social class, unemployed, of African origin and to be heavy smokers. Women who did not attend were significantly less likely than attenders to have had a cervical smear within the last three years. Non-attending mothers were significantly more likely than attending mothers to be single parents. Motivation among attenders to stop smoking and drink less alcohol was increased significantly after the health check. CONCLUSION Attendance at registration health checks at these practices was poor and non-attenders tended to be more socially deprived than attenders and had relatively unhealthy lifestyles. Although the health checks increased the attenders' motivation to alter smoking and drinking habits, inviting all new patients to a health check would appear to result in poor targeting of health promotion resources and may widen inequalities in health.