Screening for cardiovascular risk factors in general practice patients: Who is being screened according to the guidelines?

Problem

High blood pressure (BP) and high cholesterol (CL) are key risk factors for cardiovascular disease (CVD). Screening patients for these risk factors according to guidelines may improve early detection of CVD. The aim of our study is to assess rates of screening for high BP and high CL in Australian general practice.

Approach

Patients attending general practices were asked to complete a cross-sectional touch-screen survey that assessed self-reported screening for high BP and high CL. Each patient’s general practitioner (GP) also completed a paper-based survey that assessed whether each patient was overdue for screening. Screening data were analysed for all patients and GP-patient differences were analysed for patients with GP-completed checklists.

Findings

The proportion of patients who reported being screened according to guidelines was high (high BP = 93%; high CL = 78%). Compared with patient self-report, GPs reported significantly fewer patients as overdue for CL screening (difference = -6.7%, 95% CI 3.8-9.6%, p < 0.0001), particularly patients who were classified as ‘high risk’ (difference = -16.4%, 95% CI -8.7%-24.1%, p < 0.005). No difference was found for BP screening. Non-Caucasian patients (OR: 2.55, [95% CI 1.11-5.86]) and those with existing high BP (OR: 3.22, [95%CI 1.11-9.39]) have increased odds of being missed by GPs for BP screening. Patients with existing high CL (OR: 3.17, [95%CI 1.46-6.90]) who do not know their family CVD history (OR: 4.10, [95%CI 1.05-15.99]) or have a university-level education (OR: 2.22, [95%CI 1.09-4.49]) have increased odds of being missed by GPs as overdue for CL screening.

Consequences

Despite increased emphasis on preventive health activities in Australian primary care settings, evidence-practice gaps still exist particularly for CL screening.