Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients
Authors: Carter Jessica , Goldsmith Lucy P , Knights Felicity , Deal Anna , Jayakumar Subash , Crawshaw Alison F , Seedat Farah , Aspray Nathaniel , Zenner Dominik , Harris Philippa , Ciftci Yusuf , Wurie Fatima , Majeed Azeem , Harris Tess , Matthews Philippa , Hall Rebecca , Requena-Mendez Ana , Hargreaves Sally 
Published: June 2024

Background

Migrants to the UK face disproportionate risk of infections, non-communicable diseases, and under-immunisation compounded by healthcare access barriers. Current UK migrant screening strategies are unstandardised with poor implementation and low uptake. Health Catch-UP! is a collaboratively produced digital clinical decision support system that applies current guidelines (UKHSA and NICE) to provide primary care professionals with individualised multi-disease screening (7 infectious diseases/blood-borne viruses, 3 chronic parasitic infections, 3 non-communicable disease or risk factors) and catch-up vaccination prompts for migrant patients, which needs evaluating as a complex intervention to explore effectiveness and acceptability.

Methods

We carried out a mixed-methods process evaluation of Health Catch-UP! in two urban primary healthcare practices to integrate Health Catch-UP! into the electronic health record system of primary care, using the Medical Research Council framework for complex intervention evaluation. We collected quantitative data (demographics, patients screened, disease detection and catch-up vaccination rates) and qualitative participant interviews to explore acceptability and feasibility.

Results

99 migrants were assessed by Health Catch-UP! across two sites (S1, S2). 96.0 % (n=97) had complete demographics coding with Asia 31.3 % (n= 31) and Africa 25.2% (n=25) the most common continents of birth (S1 n=92 [48.9% female (n=44); mean age 60.6 years (SD 14.26)]; and S2 n=7 [85.7% male (n=6); mean age 39.4 years (SD16.97)]. 61.6% (n=61) of participants were eligible for screening for at least one condition and uptake of screening was high 86.9% (n= 53). Twelve new conditions were identified (12.1% of study population) including hepatitis C (n=1), hypercholesteraemia (n= 6), pre-diabetes (n=4) and diabetes (n=1). Health Catch-UP! identified that 100% (n=99) of patients had no immunisations recorded; however, subsequent catch-up vaccination uptake was poor (2.0%, n=1). Qualitative data supported acceptability and feasibility of Health Catch-UP! from staff and patient perspectives, and recommended Health Catch-UP! integration into routine care (e.g. NHS health checks) but required an implementation package including staff and patient support materials, standardised care pathways (screening and catch-up vaccination, laboratory, and management), and financial incentivisation.

Conclusions

Clinical Decision Support Systems like Health Catch-UP! can improve disease detection and implementation of screening guidance for migrant patients but require robust testing, resourcing, and an effective implementation package to support both patients and staff.