Barriers to Non-HDL Cholesterol Goal Attainment by Providers

Health Policy and Quality Program, Michael E. DeBakey VA Medical Center, Health Services Research and Development Center of Excellence and Section of Health Services Research, Baylor College of Medicine, Houston, TX 77030, USA.
The American journal of medicine (Impact Factor: 5). 09/2011; 124(9):876-80.e2. DOI: 10.1016/j.amjmed.2011.02.012
Source: PubMed


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.
Based on a conceptual model, we designed a questionnaire that was administered to internal medicine, family practice, cardiology, and endocrinology providers attending continuous medical education conferences. Responses were compared with those of providers attending a clinical lipidology conference.
The response rate was 33.3% (354/1063). 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≤.01) to have read the Adult Treatment Panel 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 Adult Treatment Panel III guidelines (34%) and of knowledge regarding non-HDL-C importance (21%) and calculation (22.7%) were the most common barriers identified.
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.

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    • "c o m / i j c -m e t a b o l i c -a n d -e n d o c r i n e high triglycerides N200 mg/dL plus non-HDL-C N 130 mg/dL with low HDL-C [b40 mg/dL]) and acute coronary syndromes. More recently, there have been reports of suboptimal achievement of the combined LDL-C and non-HDL-C goal in hypertriglyceridemic and high-risk patients [10] [11]. This may be partly due to lack of awareness of the non-HDL-C goal [10,12], but there may also be variability in the effectiveness of different lipid-lowering treatments on non-HDL-C. "
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    International Journal of General Medicine 12/2011; 4:853-70. DOI:10.2147/IJGM.S26562
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