Cholesterol measurement and treatment in community practices

A study was designed to examine the cholesterol measurement and treatment activities of primary care physicians in community practices. Three family practices of comparable size (one faculty practice and two community small-group practices) participated in the study. A random sample of 450 adult patients (150 from each site) was drawn from patient logs using a time series sampling method. Charts were reviewed for serum lipid evaluations, documentation of coronary heart disease risk factors, lipid-lowering activities, and other coronary heart disease risk-factor interventions. Sixty-seven percent of the sample had cholesterol measures recorded. No differences were found in the rates of measurement for men and women. Multiple, detailed serum lipid evaluations were common, and recognition of high cholesterol as a problem even before 1980 was apparent. Almost one half (47%) of individuals with cholesterol greater than 5.2 mmol/L (200 mg/dL) had a charted intervention, 64% if cholesterol greater than 6.2 mmol/L (240 mg/dL). Diet was the most common intervention (73%), and medication was used in only eight cases. Nonpharmaceutical interventions appeared to be undercharted. An analysis of interpractice variations revealed strikingly consistent results, although some interesting differences were noted. These rates are at least double previously reported rates and suggest that primary care physicians play a major role in this national priority.