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Family Physician’s Knowledge, Beliefs, and Self-reported Practice Patterns Regarding Hyperlipidemia: A National Research Network (NRN) Survey

From Brown University Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI (CBE)
University of Wisconsin Medical School, Madison, WI (PEM)
American Academy of Family Physicians, Leawood, KS (JMG, JAK, AJB)
Department of Sociology, University of Missouri-Kansas City, Kansas City, MO (JMG)
Pritzker School of Medicine, The University of Chicago, Chicago, IL (JMH)

Correspondence: Corresponding author: Aaron J. Bonham, MS, American Academy of Family Physicians, National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672 (E-mail: abonham{at}aafp.org)

Objective: Family physicians have the potential to make a major impact on reducing the burden of cardiovascular disease through the optimal assessment and management of hyperlipidemia. We were interested in assessing the knowledge, beliefs, and self-reported practice patterns of a representative sample of family physicians regarding the assessment and management of hyperlipidemia 2 years after the release of the evidence-based National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines.

Methods: A 33-item survey was mailed to a random sample (N = 1200) of members of the American Academy of Family Physicians in April of 2004, with 2 follow-up mailings to nonresponders. Physicians were queried about sociodemographic characteristics, their knowledge, attitudes, and self-reported practice patterns regarding the assessment and management of hyperlipidemia. Four case scenarios also were presented.

Results: Response rate was 58%. Over 90% of surveyed family physicians screened adults for hyperlipidemia as part of a cardiovascular disease prevention strategy. Most (89%) did this screening by themselves without the support of office staff, and 36% reported routine use of a flow sheet. Most had heard of the ATP III guidelines (85%), but only 13% had read them carefully. Only 17% of respondents used a coronary heart disease (CHD) risk calculator usually or always. Over 90% of those responding reported using low-density lipoprotein (LDL) as the treatment goal but only 76% reported using non-high-density lipoprotein (HDL) cholesterol as a secondary goal of therapy.

Conclusion: We found a large variability in knowledge, beliefs, and practice patterns among practicing family physicians. We found general agreement on universal screening of adults for hyperlipidemia as part of cardiovascular disease prevention strategy and use of LDL cholesterol as a treatment goal. Many other aspects of the NCEP ATP III guidelines, such as use of a systematic, multidisciplinary approach, using non-HDL cholesterol as a secondary goal, routinely using a CHD risk calculator for risk assessment to guide cholesterol management, have not yet penetrated into self-reported clinical practice.