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Progress and Missed Opportunities

Wayne H. Giles, MD, MS; Robert F. Anda, MD, MS; Diane H. Jones, PhD; Mary K. Serdula, MD, MPH; Robert K. Merritt, MA; Frank DeStefano, MD, MPH

JAMA. 1993;269(9):1133-1138.

Abstract
Objective.
—To investigate recent trends in the percentage and characteristics of patients being treated by a physician for high blood cholesterol (HBC) and to assess missed clinical opportunities to screen for HBC.

Design, Setting, Participants.
—Telephone interviews of 154735 adults in 37 states that participated in the Behavioral Risk Factor Surveillance System during 1988-1990 to assess trends in the percentage of patients treated for HBC by a physician. An opportunity was considered missed if a person did not report being screened for HBC despite seeing a physician for preventive care in the last 2 years.

Results.
—Between the first quarter of 1988 and the last quarter of 1990, the percentage of persons treated by a physician for HBC increased from 7.6% to 11.7% (P<.001). However, since an estimated 36% of US adults need treatment for HBC, fewer than one third of persons who need treatment are receiving it. Persons with two or more cardiac risk factors were more likely to be treated, while men, blacks, persons in lower socioeconomic groups, and persons between 20 and 34 years of age were less likely to be treated. Among the 126571 persons who had seen a physician for preventive care within the last 2 years, missed opportunities to screen for HBC were most common among persons aged 20 through 34 years (59%) and among women who had seen obstetricians/gynecologists for preventive care (43%).

Conclusions.
—Fewer than one third of persons who need treatment for HBC as estimated by data from the second National Health and Nutrition and Nutrition Examination Survey are receiving treatment. Better use of clinical opportunities to screen for HBC could substantially accelerate the progress in identifying persons, young adults in particular, who are likely to benefit from cholesterol reduction.

(JAMA. 1993;269:1133-1138)

Author Affiliations
From the Cardiovascular Health Studies Branch, Division of Chronic Disease Control and Community Intervention (Drs Giles, Anda, Jones, and DeStefano and Mr Merritt), and the Epidemiology Branch, Division of Nutrition (Dr Serdula), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga; and the Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore (Dr Giles).

Footnotes
Reprint requests to Mailstop K-47, CDC, 4770 Buford Hwy NE, Atlanta, GA 30341-3724 (Dr Giles).

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