Management of high blood cholesterol by primary care physicians: diffusion of the National Cholesterol Education Program Adult Treatment Panel guidelines.

OBJECTIVE: To study knowledge of and adherence to National Cholesterol Education Program Adult Treatment Panel (ATP) guidelines among primary care physicians.
DESIGN: Cross-sectional telephone survey.
SETTING: New York State primary care practitioners; survey conducted November 1988-January 1989. PARTICIPANTS: Physicians in general practice, family practice, internal medicine without subspecialty, and cardiology who reported greater than or equal to 10 hours/week of clinical practice (n = 329; response rate = 63%).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: While 84% of physicians had heard of the ATP guidelines, gaps in knowledge and inconsistencies between ATP recommendations and clinical practices were found. Although the ATP guidelines recommend six months of dietary therapy before starting drug treatment, 41% of physicians would initiate drug treatment for a healthy 40-year-old man with total cholesterol of 7.8 mmol/L (300 mg/dl) either at the initial visit or after one month of lipid-lowering diet. Multivariate analysis of a 24-item knowledge scale revealed that less knowledgeable physicians were more likely to be older, lack board certification, and have a specialty other than cardiology (p less than 0.01). Less knowledgeable physicians were also more likely to consider drug company literature and drug company representatives very useful sources of information about cholesterol (p = 0.02).
CONCLUSION: This study suggests that hard-to-reach physician groups may require special efforts to communicate consensus guidelines of major importance to clinical practice.