Selective Opportunistic Screening for Hypercholesterolemia in Primary Care Practice

• Published in: Journal of clinical epidemiology Vol. 51; no. 10; pp. 817 - 825
• Main Authors: Hutchison, Brian, Birch, Stephen, Evans, C.Edward, Goldsmith, Laurie J., Markham, Barbara A., Frank, John, Paterson, Michael
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1998; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Coronary Disease - etiology; Cross-Sectional Studies; Disorders of blood lipids. Hyperlipoproteinemia; Group Practice; Humans; hypercholesterolemia; Hypercholesterolemia - complications; Hypercholesterolemia - prevention & control; Mass Screening - methods; Mass Screening - standards; Medical Audit; Medical sciences; Metabolic diseases; Middle Aged; Ontario; Patient Selection; performance appraisal; primary care; Primary Health Care; Reproducibility of Results; Retrospective Studies; Risk Factors; Screening; Surveys and Questionnaires; Canada; North America; America; Ontario; Screening; primary care; hypercholesterolemia; performance appraisal; Human; Evaluation; Sanitary program; Hypercholesterolemia; Metabolic diseases; Lipids; Hyperlipoproteinemia; Dyslipemia; Medical screening; Epidemiology; Public health
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/S0895-4356(98)00068-7

Objectives: To assess the performance of selective opportunistic screening in a primary care group practice. Design: Cross-sectional survey of coronary heart disease risk factors and retrospective chart audit of cholesterol testing. Setting: Capitation-funded primary care group practice in Ontario, Canada. Subjects: 7785 enrolled patients between the ages of 20 and 69 years. Intervention: Protocol-based selective opportunistic screening program for hypercholesterolemia of 45 months duration. Main Outcome Measures: Targeting (proportion of screening tests that were appropriate), coverage (proportion of those meeting screening criteria who had a screening test performed), over-screening (proportion of those not meeting screening criteria who had a screening test performed), and screening ratio (likelihood that a screening test was performed on an individual who met screening criteria rather than one who failed to meet screening criteria). Results: 64.7% of patients tested met the practice criteria for screening. 37.7% of patients who met the practice screening criteria were tested and 24.9% of those not meeting practice screening criteria had a cholesterol test performed. The screening ratio was 1.52. Conclusion: Our findings bring into question the effectiveness of opportunistic approaches to preventive care.