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Compliance with childhood cholesterol screening among members of a prepaid health plan
R P Bachman1, E J Schoen, A Stembridge
1Department of Pediatrics, Kaiser Permanente Medical Center, Oakland, CA 94611-5693.
Insights
Parental compliance with childhood cholesterol screening is low, even without financial barriers. This highlights challenges in pediatric health interventions requiring multiple steps and education.
Area of Science:
- Pediatric Health
- Preventive Cardiology
- Public Health Interventions
Background:
- Childhood hypercholesterolemia screening is crucial for early detection of cardiovascular disease risk factors.
- Family history of hypercholesterolemia, coronary heart disease, and stroke are key indicators for initiating pediatric cholesterol screening.
- Prepaid health plans aim to reduce financial barriers to healthcare, facilitating adherence to screening and intervention protocols.
Purpose of the Study:
- To evaluate parental compliance with a comprehensive childhood cholesterol screening and intervention program.
- To identify compliance rates at various stages of the screening and intervention pathway.
- To assess the effectiveness of a nutrition program offered to children with elevated cholesterol levels.
Main Methods:
- A cohort of 1160 children aged 2-18 years underwent screening based on family history.
- Children with elevated total cholesterol (≥4.80 mmol/L) were invited for fasting blood tests and subsequent intervention.
- Interventions included telephone calls, letters, and a nutrition program for eligible participants.
Main Results:
- Only 46% of children had positive family histories, and 70% of those completed the initial cholesterol test.
- Compliance with follow-up testing for elevated cholesterol was 38%.
- Only 36% of children eligible for the nutrition program enrolled, indicating low adherence to intervention.
Conclusions:
- Parental compliance with childhood cholesterol screening and intervention programs is suboptimal.
- The multi-step nature of the screening and the educational intervention present significant compliance challenges.
- Improving adherence is critical for the success of pediatric cardiovascular risk management strategies.
Objective:
To assess compliance with cholesterol screening and intervention by children who were members of a prepaid health plan in which there was no financial barrier to intervention.
Research Design:
Children with family histories of hypercholesterolemia, coronary heart disease, and stroke were advised to have a random cholesterol test. Those with total cholesterol levels of 4.80 mmol/L (185 mg/dL) or higher were asked to return for a fasting blood test; of this group, compliant subjects with low-density lipoprotein values of 3.25 mmol/L (125 mg/dL) or higher were offered a nutrition program.
Setting:
Kaiser Permanente Medical Center, Oakland, Calif.
Subjects And Participants:
The parents of 1160 children aged 2 to 18 years who had routine pediatric appointments at Kaiser Permanente Medical Center were asked to complete screening forms on family history.
Selection Procedures:
Children with family histories of hypercholesterolemia, coronary heart disease, and stroke were advised to have a random cholesterol test. Subjects with total cholesterol levels of 4.80 mmol/L or higher were asked to return for a fasting test, and subjects with low-density lipoprotein levels of 3.25 mmol/L or higher were offered a nutrition program.
Interventions:
Telephone call, letter, low-cholesterol diet, and nutrition program.
Main Outcome Measures:
Of the 1,160 subjects contacted, 529 (46%) had positive family histories. Of these subjects, random blood cholesterol levels were determined for 369 (70%); 160 (30%) did not comply. Ninety-three subjects had total cholesterol levels of 4.80 mmol/L or higher; of these, 35 (38%) did not comply with follow-up testing. Of the 58 compliant subjects, 25 (43%) had low-density lipoprotein values of 3.25 mmol/L or higher and were offered either a 3-week or a 6-week nutrition program. Only nine subjects (36%) enrolled; 16 (64%) did not comply.
Conclusions:
Parents do not comply well with a childhood cholesterol screening program that involves two blood tests and moderately intensive educational intervention. Compliance is an important component of cholesterol screening and intervention.