Learning from the universal, proactive outreach of the Brazilian Community Health Worker model: impact of a Community Health and Wellbeing Worker initiative on vaccination, cancer screening and NHS health check uptake in a deprived community in the UK

BMC Health Services Research

Research

Cornelia Junghans¹  Matthew Harris¹  Alison Williams¹  Grazia Antonacci² 

[1] Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3Rd Floor Reynolds Building, St Dunstan’s Road, W6 8RP, London, UK;Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3Rd Floor Reynolds Building, St Dunstan’s Road, W6 8RP, London, UK;Centre for Health Economics and Policy Innovation (CHEPI), Business School, Imperial College London, London, UK;

关键词: Vaccination uptake;    Screening uptake;    Community Health Workers;    Prevention;    Hyperlocal;    Reverse Innovation;    Access to healthcare;   

DOI  :  10.1186/s12913-023-10084-8

 received in 2023-04-18, accepted in 2023-09-28,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDelays in preventative service uptake are increasing in the UK. Universal, comprehensive monthly outreach by Community Health and Wellbeing Workers (CHW), who are integrated at the GP practice and local authority, offer a promising alternative to general public health campaigns as it personalises health promotion and prevention of disease holistically at the household level. We sought to test the ability of this model, which is based on the Brazilian Family Health Strategy, to increase prevention uptake in the UK.MethodsAnalysis of primary care patient records for 662 households that were allocated to five CHWWs from July 2021. Primary outcome was the Composite Referral Completion Indicator (CRCI), a measure of how many health promotion activities were received by members of a household relative to the ones that they were eligible for during the period July 2021-April 2022. The CRCI was compared between the intervention group (those who had received at least one visit) and the control group (allocated households that were yet to receive a visit). A secondary outcome was the number of GP visits in the intervention and control groups during the study period and compared to a year prior.ResultsIntervention and control groups were largely comparable in terms of household occupancy and service eligibilities. A total of 2251 patients in 662 corresponding households were allocated to 5 CHWs and 160 households had received at least one visit during the intervention period. The remaining households were included in the control group. Overall service uptake was 40% higher in the intervention group compared to control group (CRCI: 0.21 ± 0.15 and 0.15 ± 0.19 respectively). Likelihood of immunisation uptake specifically was 47% higher and cancer screening and NHS Health Checks was 82% higher. The average number of GP consultations per household decreased by 7.4% in the intervention group over the first 10 months of the pilot compared to the 10 months preceding its start, compared with a 0.6% decrease in the control group.ConclusionsDespite the short study period these are promising findings in this deprived, traditionally hard to reach community and demonstrates potential for the Brazilian community health worker model to be impactful in the UK. Further analysis is needed to examine if this approach can reduce health inequalities and increase cost effectiveness of health promotion approaches.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 3