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Patterns of physicians' treatments for referral patients from public cholesterol screening
L A Maiman1, P Greenland, N G Hildreth
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York.
Insights
Physicians prescribed diet for 75% of patients referred from cholesterol screenings, but medication for only 16%. Current treatment guidelines for high cholesterol may be ineffective, necessitating further physician education.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Background:
- Growing public interest in high blood cholesterol necessitates evaluating physician adherence to national treatment guidelines.
- Public cholesterol screenings identify individuals needing medical follow-up, raising questions about physician response to referrals.
Purpose of the Study:
- To assess the relationship between referral characteristics from public cholesterol screenings and physician treatment practices.
- To determine if current national assessment and treatment recommendations for high cholesterol are being followed by physicians.
Main Methods:
- Analysis of 1,324 subjects who sought physician care after referral from public cholesterol screenings.
- Logistic regression adjusted for sociodemographic factors and coronary heart disease (CHD) risk factors to analyze treatment receipt (diet and medication).
Main Results:
- 75% of subjects received dietary advice, while only 16% were prescribed medication by their physicians.
- Screening cholesterol risk level, prior high cholesterol history, and type of medical contact influenced treatment.
- Other CHD risk factors were underutilized in treatment decisions; moderate-risk subjects without prior history received less dietary advice.
Conclusions:
- Current treatment guidelines for hypercholesterolemia may not be fully effective in practice.
- There is a need for ongoing physician education regarding the management of high cholesterol and its associated risks.
Abstract:
Current interest in high blood cholesterol and attendance at public cholesterol screening programs has raised the issue of whether physicians are responding to referrals according to existing national assessment and treatment recommendations. This study assessed the relationship of characteristics of referrals from a series of public blood cholesterol screenings to physicians' treatment practices. For this analysis, the sample was restricted to 1,324 subjects, from the 2,109 referred, who reported seeking physician care. At five months after screening, 75% of subjects reported their physician prescribed a diet; 16% of physicians prescribed medication. Multiple logistic regression, adjusted for sociodemographic characteristics and other coronary heart disease (CHD) risk factors, indicated that screening cholesterol risk level, prior history of high blood cholesterol levels, and type of medical contact were consistently related to receipt of diet and medication treatment, but other CHD risk factors were underutilized. "Moderate" risk subjects with no history of high blood cholesterol were less likely to have received dietary advice, but a screening-risk level interaction did not occur for medication. The results imply that current treatment guidelines may not be working and suggest the need for continued physician education in the management of hypercholesterolemia.