Selective opportunistic screening for hypercholesterolemia in primary care practice.
OBJECTIVE
To assess the performance of selective opportunistic screening in a primary care group practice.


METHODS
Cross-sectional survey of coronary heart disease risk factors and retrospective chart audit of cholesterol testing.


METHODS
Capitation-funded primary care group practice in Ontario, Canada.


METHODS
7785 enrolled patients between the ages of 20 and 69 years.


METHODS
Protocol-based selective opportunistic screening program for hypercholesterolemia of 45 months duration.


METHODS
Targeting (proportion of screening tests that were appropriate), coverage (proportion of those meeting screening criteria who had a screening test performed), over-screening (proportion of those not meeting screening criteria who had a screening test performed), and screening ratio (likelihood that a screening test was performed on an individual who met screening criteria rather than one who failed to meet screening criteria).


RESULTS
64.7% of patients tested met the practice criteria for screening. 37.7% of patients who met the practice screening criteria were tested and 24.9% of those not meeting practice screening criteria had a cholesterol test performed. The screening ratio was 1.52.


CONCLUSIONS
Our findings bring into question the effectiveness of opportunistic approaches to preventive care.
Hutchison
B
B
Department of Family Medicine, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
Birch
S
S
Evans
C E
CE
Goldsmith
L J
LJ
Markham
B A
BA
Frank
J
J
Paterson
M
M
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000209:etiology; D003430:Cross-Sectional Studies; D006123:Group Practice; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000517:prevention & control*; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008485:Medical Audit; D008875:Middle Aged; D009864:Ontario; D018579:Patient Selection; D011320:Primary Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires