This study is designed to evaluate capillary model systems for blood cholesterol screening and to develop and assess educational - referral strategies required to deliver subjects with top quartile total cholesterol for further diagnosis and therapy. The precision and accuracy under operational conditions of two instruments (Reflotron, Vision) which measure capillary blood cholesterol levels will be compared. After completion of capillary instrument cholesterol standardization programs, a randomized trial of 3 screening and 2 educational strategies will be carried out at 3 locations (1500 subjects at a work site, 500 at a family practice center, 1000 at a blood bank). Three randomized work site groups (500 subjects per group) include a mass screening, immediate report group (MS-IR) using capillary blood cholesterol measures for immediate, individual eduction-referral, a delayed report group (MS-DR) using venous blood total cholesterol for referral, and an office based, delayed report (OB-DR) group which will receive education and individual sampling in their physician's offices. At the blood bank, 1000 subjects will be randomized into MS-IR and MS-DR groups. At the family practice center, all 500 subjects will have an office based, capillary blood, immediate report strategy (OB-IR). Nine to 12 months after first sampling, all 3000 subjects will have capillary blood cholesterol measurements to allow comparison with initial values, will fill out a questionnaire to assess any changes in health perceptions, to review the outcome of physician intervention, and to determine changes in diet-life style related to education-sampling-referral. Sensitivity and specificity of the capillary strategies to correctly identify high risk subjects will be determined by comparison to venous lipid profiles in 1,000 MS-IR, 1,000 MS-DR, and 500 OB-IR subjects. Community physicians providing care to referral subjects will be randomized into written (WE) and personal education (PE) groups. Thus, randomized comparisons of 3 screening and 2 physician education strategies will be made. Outcome measures include the fraction of targeted subjects screened, the percent of at-risk subjects correctly identified, the percent of referred individuals being studied, the percent of at-risk individuals treated, and the degree of cholesterol lowering occurring as a result of each educational-referral-screening strategy. Cost effectiveness of screening-educational strategies will be critically evaluated. Overall, the project should optimize screening and educational methodologies for diagnosis and treatment of hypercholesterolemia.
| Wones, R G; Kerman, K M; Hissa, D C et al. (1989) Comparisons of referral criteria for public screening of blood cholesterol levels. Public Health Rep 104:425-32 |
