Barriers to Non-HDL Cholesterol Goal Attainment by Providers

Abstract

Purpose Despite improvements in low-density lipoprotein cholesterol goal attainment, non–high-density lipoprotein cholesterol (non-HDL-C) goal attainment remains poor. This study assessed providers’ knowledge of, attitude toward, and practice regarding non-HDL-C. Methods Based on a conceptual model, we designed a questionnaire which was administered to internal medicine, family practice, cardiology, and endocrinology providers attending continuous medical education conferences. Responses were compared to those of providers attending a clinical lipidology conference. Results Response rate was 33.3% (354/1,063). Among providers attending nonlipidology conferences, only 26% knew that non-HDL-C was a secondary treatment target, 34% knew non-HDL-C treatment goals, 56% could calculate non-HDL-C levels, and 66% knew that non-HDL-C levels could be calculated from a standard lipid panel. Compared with providers attending the lipidology conference, the other providers were less likely (p≤0.01) to have read the Adult Treatment Panel III (ATP III) guidelines (46% vs. 98%) or to use non-HDL-C (36% vs. 91%). No differences were found between primary care and specialty providers. Lack of familiarity with ATP III guidelines (34%) and of knowledge regarding non-HDL-C importance (21%) and calculation (22.7%) were the most common barriers identified. Conclusions Major gaps remain in providers’ awareness regarding non-HDL-C definition, calculation, and goals. System-level interventions are needed across specialties to address these gaps.

Case-based educational intervention to assess change in providers' knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

“…15,17,18 Knowledge gaps assessed include providers’ familiarity with the 2013 guideline; 10 year ASCVD risk estimator and its difference from the Framingham coronary heart disease (CHD) risk estimator as recommended by the prior ATP-III guideline document; intensity of statin therapy; 4 groups that could benefit from statin therapy (patients with clinical ASCVD; patients with diabetes aged 40–75 years and without clinical ASCVD; patients aged 40–75 years without clinical ASCVD or diabetes and with 10-year ASCVD risk ≥7.5%; and patients with possible familial hypercholesterolemia [FH, i.e., with LDL-C ≥190 mg/dL]). Gaps in attitude included assessment of providers’ agreement with the guideline and 10-year ASCVD risk estimator and the providers’ belief that he/she can perform guideline-recommended care.…”

Statin Prescription Adhered to Guidelines for Patients Hospitalized due to Acute Ischemic Stroke or Transient Ischemic Attack

“…In the secondary prevention of CHD, physicians having knowledge of guidelines were more likely to initiate lipid-lowering treatment and to comply with an overall measure of guideline adherence 10. Another study also showed that a physician's lack of familiarity with and knowledge of guidelines were identified as important barriers to an appropriate management of dyslipidemia 11. Regarding the management of blood pressure, physicians familiar with the Joint National Committee guidelines were more likely to recognize the blood pressure threshold for initiating blood-pressure-lowering therapy as recommended in the guidelines 12.…”

Goal setting in cardiac rehabilitation: Implications for clinical practice

“…(Oldridge, et al, 1999) Research has demonstrated the importance of helping patients identify specific behaviour as well as prioritizing goals in order to modify their risk factors and improve cardiac outcomes. (Ertzgaard, Ward, Wissel, & Borg, 2011;Virani et al, 2011) In contemporary health care, resource allocation is generally based on effectiveness in providing patient care, and cardiac rehabilitation is no exception. (Sanderson, Southard, & Oldridge, 2004) It is well know that cardiac rehabilitation coordinators provide high quality service, (Sanderson, et al, 2004) however without documented outcomes the evidence to support resource allocation is limited.…”