EFFECTS OF INTERVENTION ON COMPLIANCE TO REFERRAL AND LIFE-STYLE RECOMMENDATIONS GIVEN AT CHOLESTEROL SCREENING PROGRAMS

To enhance compliance to physician referral as well as dietary and oth er lifestyle recommendations given at blood cholesterol (BC) screening programs, we randomized Pawtucket Heart Health Program SCORE (screeni ng, counseling, referral event) participants with elevated BC levels i nto one of four groups: usual care group; a participant intervention g roup (mailed reminder letter and refrigerator magnet); a physician int ervention group (mailed packet to participant's physician including le tter, National Cholesterol Education Program [NCEP] guidelines, and pr eaddressed postcard to mail to patient); and a group that received bot h interventions. Beginning four months after the screening, we surveye d study subjects by phone. The participant intervention increased reca ll of physician referral and dietary recommendations; however, neither intervention successfully improved compliance to referral or dietary and lifestyle recommendations. Overall, 58%, 67%, and 34% of subjects reported complying to physician referral, dietary recommendations, and lifestyle recommendations, respectively. Referral compliance was asso ciated with a longer time interval between screening and survey (relat ive risk [RR] = 1.3, 95% confidence interval [CI] = 1.0, 1.7), possess ion of medical insurance that covered physician visits (RR = 2.1, 95% CI = 0.98, 4.4), and history of hypertension (RR = 2.6, 95% CI = 1.1, 5.8). Dietary compliance was positively associated with baseline BC le vels greater-than-or-equal-to 240 mg/dL (RR = 3.3, 95% CI = 1.4, 7.3) and negatively associated with increasing age; each one year increase in age corresponded to a 3% decrease in compliance (RR = 0.97, 95% CI = 0.9, 1.0). More research is needed to determine the barriers to refe rral compliance, the best ways to encourage subjects to comply with re ferral recommendations, and the most cost-effective methods to improve compliance to dietary and other lifestyle recommendations.