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Change in Cholesterol Awareness and Action: Results From National Physician and Public Surveys

Change in Cholesterol Awareness and Action: Results From National Physician and Public Surveys Abstract The National Heart, Lung, and Blood Institute, Bethesda, Md, sponsored national telephone surveys of practicing physicians and the adult public in 1983, 1986, and 1990 to assess attitudes and practices regarding high serum cholesterol levels. Each time, approximately 1600 physicians and 4000 adults were interviewed. Trends show continuing change in medical practice and public health behavior relating to serum cholesterol. In 1990, physicians reported treating serum cholesterol at considerably lower levels than in 1986 and 1983. The median range of serum cholesterol at which diet therapy was initiated was 5.17 to 5.66 mmol/L (200 to 219 mg/dL) in 1990, down from 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1986 and 6.72 to 7.21 mmol/L (260 to 279 mg/dL) in 1983. The median ranges for initiating drug therapy were 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1990, 7.76 to 8.25 mmol/L (300 to 319 mg/dL) in 1986, and 8.79 to 9.28 mmol/L (340 to 359 mg/dL) in 1983. The number of adults who reported having had their cholesterol level checked rose from 35% to 46% to 65% in 1983, 1986, and 1990, respectively. Between 1983 and 1990, the number of adults reporting a physician diagnosis of high serum cholesterol increased from 7% to 16%; the number reporting a prescribed cholesterol-lowering diet increased from 3% to 9%. Reports of self-initiated diet efforts reached a high of 19% in 1986 and decreased to 15% in 1990. Two percent of adults reported drug prescriptions in 1990 compared with 1% in earlier years. In 1990, over 90% of physicians reported awareness and use of the recommendations from the Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, and the public reported marked increases in awareness of dietary methods to lower serum cholesterol. These changes suggest educational gains; the data also suggest areas for continued cholesterol educational initiatives. (Arch Intern Med. 1991;151:666-673) References 1. Inter-Society Commission for Health Disease Resources: Primary prevention of atherosclerotic diseases . Circulation. 1970;42:A55-A94. 2. Consensus Conference Statement on Lowering Blood Cholesterol to Prevent Heart Disease . JAMA. 1985;253:2080-2086.Crossref 3. Lenfant C. A new challenge for America: the National Cholesterol Education Program . Circulation. 1986;73:855-856.Crossref 4. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Arch Intern Med. 1988;148:36-69.Crossref 5. National Cholesterol Education Program. Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction; November 1990 . Bethesda, Md: National Institutes of Health, National Heart, Lung, and Blood Institute; 1990. Publication NIH 90-3046. 6. American Heart Association, Nutrition Committee. Dietary guidelines for healthy American adults: a statement for physicians and health professionals . Circulation. 1988;77:721A-724A.Crossref 7. US Department of Agriculture/Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans . 2nd ed. Washington, DC: US Department of Agriculture/Department of Health and Human Services; 1985. Publication HG-232. 8. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial Results, I: reduction in incidence of coronary heart disease . JAMA. 1984;251:351-364.Crossref 9. Schucker B, Wittes J, Cutler J, et al. Change in physician perspective on cholesterol and heart disease: results from two national surveys . JAMA. 1987;258:3521-3526.Crossref 10. Schucker B, Bailey K, Heimback J, et al. Change in public perspective on cholesterol and heart disease: results from two national surveys . JAMA. 1987;258:3527-3531.Crossref 11. Dixon WJ, Brown MB, Engelman L, Jennrich RI. BMDP Statistical Software Manual . Berkeley, Calif: University of California Press; 1990;1. 12. Lomas J, Anderson G, Domnick-Pierre K, Vayda E, Enkin M, Hannah W. Do practice guidelines guide practice? the effect of a consensus statement on the practice of physicians . N Engl J Med. 1990;321:1306-1311.Crossref 13. Bostick RM, Luepker RV, Kofron PM, Pirie PL. Changes in physician practice for the prevention of cardiovascular disease . Arch Intern Med. 1991;151:478-484.Crossref 14. Grundy SM, Goodman DS, Rifkind BM, Cleeman JI. The place of HDL in cholesterol management: a perspective from the National Cholesterol Education Program . Arch Intern Med. 1989;149:505-510.Crossref 15. Wysowski D, Kennedy D, Gross T. Prescribed use of cholesterol-lowering drugs in the United States, 1978 through 1988 . JAMA. 1990;263:2185-2188.Crossref 16. Jacoby I, Clark S. Direct mailing as a means of disseminating NIH consensus statement: a comparison with current techniques . JAMA. 1986;255:1328-1330.Crossref 17. Kosecoff J, Kanouse D, Rogers W, McCloskey L, Winslow C, Brook R. Effects of the National Institutes of Health Consensus Development Program on Physician Practice . JAMA. 1987;258:2708-2713.Crossref 18. Soumerai S, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making . JAMA. 1990;263:549-556.Crossref 19. Steinbrook R, Lo B. Informing physicians about promising new treatments for severe illnesses . JAMA. 1990;263:2078-2082.Crossref 20. Goldman L. Changing physicians' behavior: the pot and the kettle . N Engl J Med. 1990;322:1524-1525.Crossref 21. Winkler J, Kanouse D, Brodsley L, Brook R. Popular press coverage of eight National Institutes of Health consensus development topics . JAMA. 1986;255:1323-1327.Crossref 22. Centers for Disease Control. Factors related to cholesterol screening, cholesterol level awareness—United States, 1989 . JAMA. 1990;264:2985-2986.Crossref 23. Garber AM. Where to draw the line against cholesterol . Ann Intern Med. 1989;111:625-626.Crossref 24. Olson RE. Mass intervention vs screening and selective intervention for the prevention of coronary heart disease . JAMA. 1986;255:2204-2207.Crossref 25. Becker M, Janz N. Practicing health promotion: the doctor's dilemma . Ann Intern Med. 1990;113:419-422.Crossref 26. Blair T, Bryant F, Bocuzzi S. Treatment of hypercholesterolemia by a clinical nurse using a stepped-care protocol in a nonvolunteer population . Arch Intern Med. 1988;148:1046-1048.Crossref 27. Crouch M, Sallis J, Farquhar J, et al. Personal and mediated health counseling for sustained dietary reduction of hypercholesterolemia . Prev Med. 1986;15:282-291.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Change in Cholesterol Awareness and Action: Results From National Physician and Public Surveys

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400040020006
Publisher site
See Article on Publisher Site

Abstract

Abstract The National Heart, Lung, and Blood Institute, Bethesda, Md, sponsored national telephone surveys of practicing physicians and the adult public in 1983, 1986, and 1990 to assess attitudes and practices regarding high serum cholesterol levels. Each time, approximately 1600 physicians and 4000 adults were interviewed. Trends show continuing change in medical practice and public health behavior relating to serum cholesterol. In 1990, physicians reported treating serum cholesterol at considerably lower levels than in 1986 and 1983. The median range of serum cholesterol at which diet therapy was initiated was 5.17 to 5.66 mmol/L (200 to 219 mg/dL) in 1990, down from 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1986 and 6.72 to 7.21 mmol/L (260 to 279 mg/dL) in 1983. The median ranges for initiating drug therapy were 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1990, 7.76 to 8.25 mmol/L (300 to 319 mg/dL) in 1986, and 8.79 to 9.28 mmol/L (340 to 359 mg/dL) in 1983. The number of adults who reported having had their cholesterol level checked rose from 35% to 46% to 65% in 1983, 1986, and 1990, respectively. Between 1983 and 1990, the number of adults reporting a physician diagnosis of high serum cholesterol increased from 7% to 16%; the number reporting a prescribed cholesterol-lowering diet increased from 3% to 9%. Reports of self-initiated diet efforts reached a high of 19% in 1986 and decreased to 15% in 1990. Two percent of adults reported drug prescriptions in 1990 compared with 1% in earlier years. In 1990, over 90% of physicians reported awareness and use of the recommendations from the Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, and the public reported marked increases in awareness of dietary methods to lower serum cholesterol. These changes suggest educational gains; the data also suggest areas for continued cholesterol educational initiatives. (Arch Intern Med. 1991;151:666-673) References 1. Inter-Society Commission for Health Disease Resources: Primary prevention of atherosclerotic diseases . Circulation. 1970;42:A55-A94. 2. Consensus Conference Statement on Lowering Blood Cholesterol to Prevent Heart Disease . JAMA. 1985;253:2080-2086.Crossref 3. Lenfant C. A new challenge for America: the National Cholesterol Education Program . Circulation. 1986;73:855-856.Crossref 4. Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Arch Intern Med. 1988;148:36-69.Crossref 5. National Cholesterol Education Program. Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction; November 1990 . Bethesda, Md: National Institutes of Health, National Heart, Lung, and Blood Institute; 1990. Publication NIH 90-3046. 6. American Heart Association, Nutrition Committee. Dietary guidelines for healthy American adults: a statement for physicians and health professionals . Circulation. 1988;77:721A-724A.Crossref 7. US Department of Agriculture/Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans . 2nd ed. Washington, DC: US Department of Agriculture/Department of Health and Human Services; 1985. Publication HG-232. 8. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial Results, I: reduction in incidence of coronary heart disease . JAMA. 1984;251:351-364.Crossref 9. Schucker B, Wittes J, Cutler J, et al. Change in physician perspective on cholesterol and heart disease: results from two national surveys . JAMA. 1987;258:3521-3526.Crossref 10. Schucker B, Bailey K, Heimback J, et al. Change in public perspective on cholesterol and heart disease: results from two national surveys . JAMA. 1987;258:3527-3531.Crossref 11. Dixon WJ, Brown MB, Engelman L, Jennrich RI. BMDP Statistical Software Manual . Berkeley, Calif: University of California Press; 1990;1. 12. Lomas J, Anderson G, Domnick-Pierre K, Vayda E, Enkin M, Hannah W. Do practice guidelines guide practice? the effect of a consensus statement on the practice of physicians . N Engl J Med. 1990;321:1306-1311.Crossref 13. Bostick RM, Luepker RV, Kofron PM, Pirie PL. Changes in physician practice for the prevention of cardiovascular disease . Arch Intern Med. 1991;151:478-484.Crossref 14. Grundy SM, Goodman DS, Rifkind BM, Cleeman JI. The place of HDL in cholesterol management: a perspective from the National Cholesterol Education Program . Arch Intern Med. 1989;149:505-510.Crossref 15. Wysowski D, Kennedy D, Gross T. Prescribed use of cholesterol-lowering drugs in the United States, 1978 through 1988 . JAMA. 1990;263:2185-2188.Crossref 16. Jacoby I, Clark S. Direct mailing as a means of disseminating NIH consensus statement: a comparison with current techniques . JAMA. 1986;255:1328-1330.Crossref 17. Kosecoff J, Kanouse D, Rogers W, McCloskey L, Winslow C, Brook R. Effects of the National Institutes of Health Consensus Development Program on Physician Practice . JAMA. 1987;258:2708-2713.Crossref 18. Soumerai S, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making . JAMA. 1990;263:549-556.Crossref 19. Steinbrook R, Lo B. Informing physicians about promising new treatments for severe illnesses . JAMA. 1990;263:2078-2082.Crossref 20. Goldman L. Changing physicians' behavior: the pot and the kettle . N Engl J Med. 1990;322:1524-1525.Crossref 21. Winkler J, Kanouse D, Brodsley L, Brook R. Popular press coverage of eight National Institutes of Health consensus development topics . JAMA. 1986;255:1323-1327.Crossref 22. Centers for Disease Control. Factors related to cholesterol screening, cholesterol level awareness—United States, 1989 . JAMA. 1990;264:2985-2986.Crossref 23. Garber AM. Where to draw the line against cholesterol . Ann Intern Med. 1989;111:625-626.Crossref 24. Olson RE. Mass intervention vs screening and selective intervention for the prevention of coronary heart disease . JAMA. 1986;255:2204-2207.Crossref 25. Becker M, Janz N. Practicing health promotion: the doctor's dilemma . Ann Intern Med. 1990;113:419-422.Crossref 26. Blair T, Bryant F, Bocuzzi S. Treatment of hypercholesterolemia by a clinical nurse using a stepped-care protocol in a nonvolunteer population . Arch Intern Med. 1988;148:1046-1048.Crossref 27. Crouch M, Sallis J, Farquhar J, et al. Personal and mediated health counseling for sustained dietary reduction of hypercholesterolemia . Prev Med. 1986;15:282-291.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1991

References