Physician management of hyperlipidemia in Saskatchewan: temporal trends and the effect of a CME program

To assess current trends in the management of hyperlipidemia by Saskatchewan physicians, and to evaluate the effect of a specific continuing medical education (CME) program.

Using a quasi-experimental design, physicians in an intervention area received the CME program while those in a comparison area did not. Management of hyperlipidemia was assessed before and after the program via a self-administered questionnaire.

All family physicians, general internists and cardiologists practising in the two areas were eligible.

Of 439 eligible physicians, 308 (70%) completed the first survey, while 268 of 447 (60%) completed the second survey. Analysis was conducted on the 221 physicians who completed both surveys.

Physicians in the intervention area received printed materials and attended a series of seminars between November 1988 and February 1989. Program content was based upon the recommendations of the Canadian Consensus Conference on Cholesterol (1988).

Over the study period the mean level of serum cholesterol considered 'ideal' for a 40- to 60-year-old male decreased significantly from 5.43 to 5.03 mmol/L (P less than 0.001). The mean level at which diet therapy was begun decreased from 6.60 to 5.78 mmol/L (P less than 0.001) with a significantly greater proportion of physicians in the intervention area (58.0%) than in the comparison area (43.2%) initiating therapy in the 5.2 to 5.6 mmol/L range (P = 0.03). The mean level of serum cholesterol at which drug therapy is begun also decreased from 7.59 to 6.82 mmol/L (P less than 0.001), with a significantly greater proportion of physicians in the intervention (41.6%) than in the comparison area (25.0%) starting therapy in the 6.2 to 6.6 mmol/L range (P = 0.03).

The management of hyperlipidemia reported by physicians in Saskatchewan changed dramatically between July 1988 and March 1989. The effect of the CME program is modest in comparison with this large temporal trend. The study provides further evidence that significant changes in the practice patterns of groups of physicians will only occur when the educational process is highly focused and personalized.