Effect of screening and referral on follow-up and treatment of high blood cholesterol levels

Public screening for elevated blood cholesterol has become a common practice, supported by national recommendations. However, little is known about the response to referral for medical follow-up of those found to have high cholesterol levels. During a one-year period, 424 adults from a population-based screening and education program were referred to medical care after twice having elevated blood cholesterol levels. When they were remeasured approximately six months later, they were contacted for a telephone interview and 98% agreed to participate. While 82% remembered the referral, only 57% had actually visited a physician. An additional 8% had had telephone contact with a physician. Of the 237 who visited a physician, 76% had a cholesterol determination done during the first visit and 76% were advised to alter their diet by changing their fat consumption or losing weight. Referral to a nutritionist was suggested for 16%. Of the 424 participants, 280 (66%) reported substantial dietary change, either self-initiated or as a result of seeing a physician. Nineteen subjects (5%) were on lipid-lowering medication at the time of the interview. These observations suggest that a substantial portion of those screened will obtain follow-up care after two elevated blood cholesterol measurements in a screening setting. However, many never receive attention for this condition. Continued public and physician education is necessary to treat hypercholesterolemic individuals appropriately.