Results of the Massachusetts Model Systems for Blood Cholesterol Screening Project
S. Havas, L. Koumjian, J. Reisman, L. Hso and S. Wozenski
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201.
OBJECTIVE.--To evaluate the effectiveness of a model blood cholesterol
screening program. DESIGN.--Principal components included physician
education, community-based screenings, and follow-up. A lay or professional
educator provided counseling and referral advice. Half of the subjects with
high blood cholesterol levels received a reminder to see their physician.
SETTING.--135 sites in four Massachusetts communities.
PARTICIPANTS.--10,428 adults. Males, the young, the poor, the less
educated, and minorities were underrepresented. MAIN OUTCOME
MEASURES.--Referral completion rates, blood cholesterol changes.
RESULTS.--51.5% of those referred had visited their physicians within 2 to
4 months, increasing to 65.6% within 6 to 12 months. Older age (odds ratio
[OR], 1.17 per additional decade), more education (OR, 1.17 per additional
level), higher blood cholesterol levels (OR, 1.19 per additional 0.51
mmol/L), previous knowledge of level (OR, 1.34), and receiving a reminder
(OR, 1.24) were significantly associated with greater likelihood of
referral completion, whereas the type of educator providing counseling was
not. Physicians had remeasured the blood cholesterol level of 76% of those
seen, given dietary counseling to 70%, and prescribed medication to 15%.
Significant changes in dietary fat were reported by both compliers and
noncompliers with advice to follow up with their physicians. Six months
after screening, blood cholesterol levels were 3.6% lower in noncompliers,
4.4% lower in compliers not taking cholesterol-lowering medications, and
8.8% in compliers taking such medications. CONCLUSIONS.--An effective,
community-based blood cholesterol screening program can attract diverse
populations and can result in most participants with high levels following
up with their physicians, making dietary changes, and lowering their
cholesterol levels. Additional strategies may be needed to attract
underrepresented groups and to reduce the apparent overuse of
cholesterol-lowering medications.
