Preventive practices for adult cardiovascular disease in children

Differences between family practitioners and pediatricians regarding appropriate interventions for cardiovascular disease prevention in pediatric patients have been described by national surveys of physicians in the two specialties. the purpose of the study reported here was to determine whether similar differences existed in a more complete sample from a confined geographical area in which local standards of care might influence physicians practicing in the locale.

Members of the Southwestern Ohio Society of Family Physicians and the Cincinnati Pediatric Society were surveyed by questionnaire about their attitudes and practices concerning cardiovascular risk factors in children. The response rate was greater than 70% in each specialty group.

Differences in the diagnosis and treatment of hypercholesterolemia were detected: (1) pediatricians screened patients at younger ages and used lower cutoff points for diagnosis (5.0 vs 5.5 mmol/L [192 vs 211 mg/dL]); and (2) family physicians were more likely to treat with medication (57% vs 5%), whereas pediatricians referred hypercholesterolemic patients to specialists more often (71% vs 19%). Both family physicians and pediatricians mislabeled blood pressures at the age-specific 90th percentile as normal (21% and 14%, respectively); this occurred more commonly with younger patients. Blood pressure was the risk factor most often measured, but smoking was the risk factor that received the most counseling by physicians in both specialties.

Both family physicians and pediatricians reported feeling inadequately prepared to counsel lifestyle changes, and ranked obesity, smoking, and cholesterol as topics of greatest interest for continuing medical education courses. Physicians in both specialties did not routinely update family history of cardiovascular disease during well-child visits.(ABSTRACT TRUNCATED AT 250 WORDS)