COMPARISON OF APPROPRIATENESS OF CHOLESTEROL TESTING IN GENERAL-PRACTICE WITH THE RECOMMENDATIONS OF NATIONAL GUIDELINES - AN AUDIT OF PATIENT RECORDS IN 20 GENERAL PRACTICES

Objective- To compare the profiles of those patients selected by gener al practitioners for measurement of serum cholesterol with the recomme nded profiles for opportunistic cholesterol testing described in the n ational practice guidelines published by the Dutch College of General Practitioners. Design- Retrospective audit of general practitioners' r ecords. Materials- Practice records of 3577 adult patients systematica lly sampled from 20 general practices. Main measures With criteria set by the national guidelines, the proportion of patients per practice ( a) for whom cholesterol testing would be considered justified, and (b) for whom cholesterol testing would be considered unjustified, and the proportion of patients within each of these groups who had had a chol esterol measurement recorded. Results- Cholesterol tests were performe d on 415 (11.7%) of the 3577 patients. National guidelines on the mana gement of hypercholesterolaemia state that a positive cardiovascular r isk profile is an indication for cholesterol measurement. Just under o ne fifth (668) of the patients in this study were recorded as having a positive cardiovascular risk profile, but only 31% of these had had t heir cholesterol measured. Of the patients without recorded evidence o f a positive cardiovascular risk profile cholesterol had been measured in 8%. Restricting the analyses to the age group 18-65 (n = 3060) of whom 12.5% had a positive risk profile, did not improve the results. I n practices with a computerised information system 37% of patients wit h recorded evidence of a positive cardiovascular risk profile had had their cholesterol measured. Conclusions- Cholesterol testing was not t argeted as selectively as recommended by the national guidelines. The major problem was failure to test those Likely to benefit. Improving t he targeting of measurements would increase workload the general pract itioners. If the national guidelines are to have an effect on health p romotion the first step must be to increase the proportion of patients with positive cardiovascular risk profiles who get their cholesterol tested. A major factor in successfully selecting cases seems to be tha t practices are equipped with a computerised medical information syste m.