A successful physician training program in cholesterol screening and management.
METHODS
Thirty-six resident physicians received a blood cholesterol training program which included training in blood cholesterol screening using a fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for follow-up diet and drug treatment. The program also included feedback to residents about their blood cholesterol screening activity, incentives, and biweekly articles in the department newsletter.


RESULTS
Between 1986-1987 (baseline) and 1987-1988 (intervention), the percentage of the target patient population (ages 20-65 years, nonpregnant, not screened in the previous year) that was screened for hypercholesterolemia in this primary care practice increased from 16.2 to 23.2% [rate difference (RD) = 7.0; 95% confidence interval (CI) = 4.75-9.25]. The mean value of the screening tests decreased from 5.36 mmol/liter (207.2 mg/dl) to 5.08 mmol/liter (196.6 mg/dl; t = 2.98, P = 0.003) and the percentage of the population screened needing further evaluation decreased from 36.8 to 27.6% (RD 9.2; CI = 2.00-14.00). In the intervention year, compared with the baseline year, patients with a borderline blood cholesterol and cardiovascular risk factors were more likely to have a follow-up test (28.8% vs 11.9%, RD = 16.9; 95% CI = 0.80-33.00) and the low-density lipoprotein cholesterol test was used less for screening (8.2% vs 19.4%, P less than 0.0001). Conclusion. We conclude that this program was effectively integrated into a busy primary care practice, leading to improvement in blood cholesterol screening and management practices.
Jack
B W
BW
Department of Family Medicine, Memorial Hospital of Rhode Island, Pawtucket.
Gans
K M
KM
McQuade
W
W
Culpepper
L
L
Lasswell
A
A
Hume
A L
AL
Dowling
P T
PT
Carleton
R A
RA
D000328:Adult; D000368:Aged; D003376:Counseling / Q000193:education / Q000592:standards; D004503:Education, Medical, Graduate / Q000379:methods / Q000592:standards*; D005194:Family Practice / Q000193:education*; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000517:prevention & control*; D007396:Internship and Residency; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D052756:Nutritional Sciences / Q000193:education; D010353:Patient Education as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D015397:Program Evaluation