The effect of physician office visits on CHD risk factor modification as part of a worksite cholesterol screening program

Background. Elevated serum cholesterol is a major risk factor for CHD. Prim ary prevention through behavioral modification has been designated first-li ne treatment for patients with elevated cholesterol. In this study, we asse ssed the impact of a physician office visit after a worksite cholesterol sc reening on self-reported changes in diet, weight loss, exercise, and smokin g. We hypothesized that those individuals who had a physician office visit regarding cholesterol would make more changes in CHD risk factors than thos e who did not have such a visit. Methods. A cohort of 4,928 participants from 33 worksites in Massachusetts and Rhode Island had baseline CHD risk factors evaluated at a cholesterol s creening and 4,473 were available at follow-up 6 months later by telephone interview. A total of 1,957 had elevated cholesterol levels (greater than o r equal to 200 mg/dl) and were instructed to visit their physician, in addi tion to receiving educational materials related to CHD risk factor modifica tion. Results. Most individuals with elevated cholesterol levels had other preval ent self-reported CHD risk factors at baseline: 58% consumed high-fat diets (>30% fat), 43% were overweight, 60% had a sedentary lifestyle (sweat-rela ted physical activity <3 x per week), and 22% were cigarette smokers. After 6 months of follow-up, 74% of participants with high-fat diets reported ea ting a lower fat diet, 71% of overweight participants reported weight loss, 53% of sedentary participants attempted to increase physical activity, and 38% of smokers decreased or quit cigarette smoking. Thirty-five percent of participants completed the referral for a physician office visit to discus s their elevated cholesterol determined at the baseline worksite screening. However, these individuals showed only a modest change (which was not stat istically significant) in self-reported CHD risk factors compared with thos e who did not have follow-up physician visits after adjusting for age, sex, race, education, occupation, medical insurance, time since last doctor vis it, diabetes, and hypertension. Objective measurements of serum cholesterol , body mass index, and dietary score were likewise modestly improved and no t statistically significant. Conclusions. In 6 months of follow-up, high absolute levels of CHD risk fac tor modification were observed after a worksite cholesterol screening. A ph ysician office visit added only a modest but not statistically significant benefit for further CHD risk factor modification. These findings indicate t hat the follow-up cholesterol-related physician visit had little added clin ical benefit over the screening intervention alone, (C)1999 American Health Foundation and Academic Press.