Selective opportunistic screening for hypercholesterolemia in primary care practice.

Objectives: To assess the performance of selective opportunistic screening in a primary care group practice. Design: Cross-sectional survey of coronary heart disease risk factors and retrospective chart audit of cholesterol testing. Setting: Capitation-funded primary care group practice in Ontario, Canada. Subjects: 7785 enrolled patients between the ages of 20 and 69 years. Intervention: Protocol-based selective opportunistic screening program for hypercholesterolemia of 45 months duration. Main Outcome Measures: Targeting (proportion of screening tests that were appropriate), coverage (proportion of those meeting screening criteria who had a screening test performed), over-screening (proportion of those not meeting screening criteria who had a screening test performed), and screening ratio (likelihood that a screening test was performed on an individual who met screening criteria rather than one who failed to meet screening criteria). Results: 64.7% of patients tested met the practice criteria for screening. 37.7% of patients who met the practice screening criteria were tested and 24.9% of those not meeting practice screening criteria had a cholesterol test performed. The screening ratio was 1.52. Conclusion: Our findings bring into question the effectiveness of opportunistic approaches to preventive care.