Practices and Attitudes Regarding Pediatric Cholesterol Screening Recommendations Differ Between Pediatricians and Family Medicine Clinicians.

Pediatricians had higher rates of ordering pediatric cholesterol screening than family medicine (FM) clinicians. This study aims to compare knowledge, attitude, and practices of clinicians' pediatric cholesterol screening practices and attitudes between these two specialties. A 14-item electronic survey using Likert scales was sent to all clinicians in the institution's Departments of Pediatrics and FM between 2018 and 2019. Chi-square and t-tests were used to compare pediatricians and FM clinicians. 22 clinicians from Pediatrics and 111 from FM completed the survey. Compared to FM clinicians, pediatricians were more familiar with the National Heart, Lung, and Blood Institute guidelines, which are more vigorous in their recommendation of universal cholesterol screening. Pediatricians reported being more supportive of universal cholesterol screening in children (p < 0.05). In practice, pediatricians reported screening almost two thirds (64.8%) of eligible patients during the past year, while FM clinicians reported screening approximately one third (34.1%) of eligible patients (p < 0.001). Pediatricians were more likely to screen based on patient-specific risk factors and their practice decisions were more heavily influenced by published guidelines, institutional education, availability of non-fasting blood to be used for screening, and the availability of an institutional pediatric lipid clinic (p < 0.05). The differences in knowledge, attitudes, and practices of cholesterol screening may contribute to different screening rates among clinicians from FM and pediatrics. To improve patient care and reduce gaps, it is important to implement interventions at the institutional level as well as to adopt uniform guideline recommendations at the national level.

Differences in pediatric cholesterol screening rates between family physicians and pediatricians correlate with conflicting guidelines.

Conflicting guidelines regarding universal pediatric cholesterol screening were released between 2011 and 2019, but the impact on screening rates remains understudied. The purpose of this study was to examine trends in pediatric cholesterol screening rates within a single institution in the United States and their association with release of national guidelines, local educational tools, and electronic health record (EHR) modifications. Order placement was defined as ordering a high-density lipoprotein cholesterol level in a patient aged 9-21 years with ≥1 well visit in prior 3 years. Order placement rate (OPR) was calculated per month using 3 months' moving average smoothing and analyzed based on date, patient age, and specialty of ordering clinician. Timing of educational tools, EHR modifications, and national guideline release were analyzed for changes in OPR. Prior to release of 2011 guidelines recommending universal pediatric cholesterol screening, pediatrician OPR was 35% (95% CI: 29-43%) compared to 8% (7-11%) for family physicians. For both specialties, OPR increased after 2011 guidelines, educational initiatives, and EHR changes, but decreased after 2016, with a larger decrease for family physicians (p < 0.001 for all). OPR was consistently higher for pediatricians than for family physicians during the study period, with largest OPR changes correlating with release of guidelines. The findings from the study suggest that conflicting guidelines may contribute to lower overall OPR, and to different screening rates for children cared for by pediatricians compared to family physicians.

Improving Universal Pediatric Lipid Screening.

OBJECTIVE: To evaluate whether the release of national guidelines, electronic health record (EHR) modifications, and educational initiatives correlated with changes in pediatricians' universal lipid screening practices. STUDY DESIGN: Retrospective review of EHRs in an academic general pediatric practice was performed to measure the prevalence of order placement. A child was "screened" if an order was placed during a well-visit between 9 and 21 years of age. The prevalence of order placement for lipid screens on 22 374 patients from January 2010 to December 2015 was analyzed for date of order and patient age, then compared with timing of guidelines, local educational initiatives, and EHR modifications. Primary study outcome was lipid screening order placement over time. RESULTS: Order placement increased from 8.9% (95% CI 8.3%-9.5%) before any intervention to 50.0% (95% CI 48.8%-51.2%) over the last 12 months of the study period (P < .001). All age groups showed significant increases in order placement. Changes in screening were seen following guideline publications, educational initiatives, and EHR modifications (for all, P < .0001). Order completion was 69.6% (95% CI 68.9%-70.3%). The composite prevalence of screening (order placement multiplied by order completion) was 46.8% over the 6-year study period. CONCLUSIONS: Improved adherence to recommendations for universal lipid screening is possible through educational initiatives and EHR modifications. Inclusion of 12- to 16-year-old adolescents/teenagers as a targeted group for universal screening in addition to recommended age groups improved screening prevalence. Similar efforts could be applicable for implementation of other guidelines.