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The IMPACT-FH Renewal Protocol: Evaluating FH Cascade Testing Implementation in Primary Care through a Pragmatic Trial, Economic Evaluation, and Mixed-Methods Sustainability Assessment.

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Using implementation science to develop a familial hypercholesterolemia screening program in primary care: The

Laney K Jones1, Katrina M Romagnoli2, Tyler J Schubert3

  • 1Department of Genomic Health, Research Institute, Geisinger, Danville, PA 17822, USA (Drs Jones, Schubert, Clegg, Cawley, Norelli, Williams, Gidding and Rahm); Heart and Vascular Institute, Geisinger, Danville, PA 17822, USA (Drs Jones). Electronic address: https://twitter.com/LaneyJonesRx.

Journal of Clinical Lipidology
|January 16, 2024
PubMed
Summary

Familial hypercholesterolemia (FH) screening is uncommon in primary care. The CARE-FH trial developed strategies to improve FH identification and guideline-based care by engaging healthcare professionals.

Keywords:
Familial hypercholesterolemiaHuman centered designIdentificationImplementation scienceImplementation strategies

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Area of Science:

  • Implementation Science
  • Public Health
  • Cardiology

Background:

  • Familial hypercholesterolemia (FH) is an underdiagnosed genetic condition leading to premature cardiovascular disease.
  • Current FH screening practices in primary care are infrequent and often reactive, typically occurring after a cardiovascular event.

Purpose of the Study:

  • To improve the screening for Familial Hypercholesterolemia (FH) in primary care settings.
  • To develop and implement strategies for guideline-based care of FH by incorporating end-user perspectives.

Main Methods:

  • Employed implementation science and human-centered design, including contextual inquiries, surveys, and engagement sessions with healthcare stakeholders.
  • Partnered with healthcare system leaders, clinicians, and staff to define current screening states and assess implementation feasibility.
  • Developed and pilot-tested multilevel strategies for FH screening and care within a primary care clinic.

Main Results:

  • Primary care clinicians reported FH screening as acceptable, appropriate, and feasible.
  • Identified barriers to screening include time constraints, testing costs, and knowledge gaps regarding dyslipidemia.
  • Facilitators for screening include clear guidance and availability of new FH therapies.

Conclusions:

  • A comprehensive implementation strategy package was developed to enhance FH awareness and identification.
  • The strategy aims to improve the initiation of guideline-based care for individuals with FH.
  • The CARE-FH trial provides a model for integrating FH screening into routine primary care.