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.
Department of Family Medicine, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
B
B
Hutchison
S
S
Birch
C E
CE
Evans
L J
LJ
Goldsmith
B A
BA
Markham
J
J
Frank
M
M
Paterson
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