D L Hahn1. 1. Arcand Park Clinic, Division of Dean Medical Center, Madison, Wisconsin 53704.
Abstract
BACKGROUND: Physicians rarely offer clinical preventive services to patients during acute care visits, but only a minority of patients schedule health maintenance visits. Consequently, many eligible patients never receive appropriate preventive care. Successful strategies are needed to deliver preventive services during acute care visits. METHODS: This study tested the feasibility and effectiveness of a simple, physician-initiated protocol for management of hypercholesterolemia in one nonacademic community primary care (family practice) practice. Cholesterol testing was offered to all adult patients (aged 18 years or older) encountered by the clinician during acute care visits, as well as during scheduled health maintenance visits. Mailed notification of cholesterol risk status with a recommendation to follow a prudent (Step I) diet was the main intervention. Some high-risk patients additionally received formal dietary counseling and lipid-lowering medication as clinically warranted. RESULTS: A total of 1334 patients (95 percent of the eligible clinical population) accepted cholesterol testing, and 158 (11.8 percent) had high cholesterol (> or = 240 mg/dL). For the 114 patients (72.2 percent) with high cholesterol (mean 275.1 mg/dL) who returned for follow-up, cholesterol change 1 year after screening was -9.2 percent (P < 0.001, compared with base line). This decrease could not be explained by expected temporal trends or regression to the mean. Assuming unchanged cholesterol values for patients not followed up, decrease for the entire clinical population with high cholesterol was -6.8 percent (95 percent confidence interval -4.9 to -8.6 percent). CONCLUSIONS: Systematic cholesterol screening during acute care visits is a feasible and effective adjunct to screening during health maintenance visits in this practice. Because most people eventually visit a primary care physician, offering clinical preventive services during acute care visits might be an effective method for reaching the entire clinical population.
BACKGROUND: Physicians rarely offer clinical preventive services to patients during acute care visits, but only a minority of patients schedule health maintenance visits. Consequently, many eligible patients never receive appropriate preventive care. Successful strategies are needed to deliver preventive services during acute care visits. METHODS: This study tested the feasibility and effectiveness of a simple, physician-initiated protocol for management of hypercholesterolemia in one nonacademic community primary care (family practice) practice. Cholesterol testing was offered to all adult patients (aged 18 years or older) encountered by the clinician during acute care visits, as well as during scheduled health maintenance visits. Mailed notification of cholesterol risk status with a recommendation to follow a prudent (Step I) diet was the main intervention. Some high-risk patients additionally received formal dietary counseling and lipid-lowering medication as clinically warranted. RESULTS: A total of 1334 patients (95 percent of the eligible clinical population) accepted cholesterol testing, and 158 (11.8 percent) had high cholesterol (> or = 240 mg/dL). For the 114 patients (72.2 percent) with high cholesterol (mean 275.1 mg/dL) who returned for follow-up, cholesterol change 1 year after screening was -9.2 percent (P < 0.001, compared with base line). This decrease could not be explained by expected temporal trends or regression to the mean. Assuming unchanged cholesterol values for patients not followed up, decrease for the entire clinical population with high cholesterol was -6.8 percent (95 percent confidence interval -4.9 to -8.6 percent). CONCLUSIONS: Systematic cholesterol screening during acute care visits is a feasible and effective adjunct to screening during health maintenance visits in this practice. Because most people eventually visit a primary care physician, offering clinical preventive services during acute care visits might be an effective method for reaching the entire clinical population.