Barriers to non-HDL cholesterol goal attainment by providers

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Conflict of interest statement

Conflict of interest statement: Dr. Virani: research grants: Merck and Co Inc, National Football League Medical Charities. Dr: Nambi: advisory board: Roche. Dr. Ballantyne: grant/research support: Abbott, AstraZeneca, Bristol-Myers/Squibb, diaDexus, GlaxoSmithKline, Kowa, Merck, Novartis, Roche, Sanofi-Synthelabo, Takeda, NIH, ADA, AHA; consultant: Abbott, Adnexus, Amylin, AstraZeneca, Bristol-Myers Squibb, Esperion, Genentech, GlaxoSmithKline, Idera Pharma, Kowa, Merck, Novartis, Resverlogix, Roche, Sanofi-Synthelabo, Takeda; speakers bureau: Abbott, AstraZeneca, GlaxoSmithKline, Merck; honoraria: Abbott, AstraZeneca, GlaxoSmithKline, Merck, Sanofi-Synthelabo, Takeda. All other authors: none.

All authors had access to the data and a role in writing the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Published by Elsevier Inc.

Figures

Figure 1

Conceptual model of why a provider may not be able to follow guidelines regarding non-HDL-C (based on conceptual model by Cabana et al.). ATP III, Adult Treatment Panel III; non-HDL-C, non–high-density lipoprotein cholesterol; TGs, triglycerides; NP, nurse practitioner; PA, physician assistant. Lack of self efficacy = provider’s belief that he/she cannot perform guideline recommendations for non-HDL-C, lack of outcome expectancy = provider’s belief that non-HDL-C goal attainment will not improve patient outcomes.