PRIMARY-CARE PRACTICE ADHERENCE TO NATIONAL CHOLESTEROL EDUCATION-PROGRAM GUIDELINES FOR PATIENTS WITH CORONARY HEART-DISEASE

Background: Clinical trials demonstrate significant benefit from chole sterol management for patients with cardiovascular disease (CVD). Nati onal guidelines recommending goals for screening and treatment were pu blished in 1993 and widely disseminated. This study examines cholester ol screening and management by primary care physicians after the guide lines were released. Methods: Medical records and patient surveys prov ided data for 603 patients with CVD, aged 27 to 70 years, from 45 prac tices in 4 states during 1993 to 1995. Physician surveys measured esti mated performance and other variables. Physician and patient factors a ssociated with adherence, or lack of adherence, to national guidelines were examined using univariate and multivariate analyses. Results: A total of 199 patients (33%) with CVD were not screened with lipid pane ls, 271 patients (45%) were not receiving dietary counseling, and 404 (67%) were not receiving cholesterol medication. Only 84 patients (14% ) with CVD had achieved the recommended low-density lipoprotein level of less than 2.58 mmol/L (100 mg/dL) and 302 (50%) had triglyceride le vels lower than 2.26 mmol/L (200 mg/dL). Patients with a revasculariza tion history and higher low-density lipoprotein and/or triglyceride le vels were more likely to receive treatment, but other patient factors, including CVD risk factors, did not predict treatment. Physician spec ialty was not associated with differences in treatment, but physicians in practice for fewer years ordered more lipid panels. Conclusions: M ost patients with CVD in primary care were not receiving cholesterol s creening and management as recommended by the National Cholesterol Edu cation Program guidelines in the 2 years after their release. Increasi ng cholesterol screening and treatment should be a priority for practi ce quality improvement and could result in significant reductions in C VD events for high-risk patients.