High Blood Cholesterol. Physician and Patient Perspectives.

Scientific evidence of the causal relationship between high blood cholesterol and risk for coronary heart disease prompted extensive professional and public interest in practical application in the 1980's. Among other things, national guidelines for lipid lowering were published in Sweden in 1988. Mass media covered the topic extensively. The aims of this study were to analyze aspects of physician and patient interpretations and uses of knowledge of hypercholesterolemia and aspects of physician and pharmacist mutual appraisals of competence for treatment of hypercholesterolemia. Swedish family physicians reported applying higher cut-off levels for treatment of hypercholesterolemia than advised in their guidelines. For reference, physicians mainly used such guidelines, and those who mentioned the guidelines reported applying lower cut-off levels. In comparison with Minnesota family physicians, Swedish physicians applied higher cut-off levels for treatment of hypercholesterolemia, and drug preferences differed. This was partly reflected in differences in national guidelines. Physicians lacked confidence in pharmacists' competence in patient counseling for hypercholesterolemia. Both physicians and pharmacists reported the need for continuing education, including skills for patient counseling. Printed patient education material concerning treatment of hypercholesterolemia, selected by physicians, contained many examples of plain facts, but rarely addressed the practical implementation of new habits in everyday life. In general, the information was not related to individual orientation of knowledge and social life-styles, and did not give a foundation for the patient to judge the information individually. Middle-aged urban men, invited to a screening for risk factors for coronary heart disease, demonstrated correlations between health beliefs, previous health related experiences and risk behavior. Men with recently discovered hypercholesterolemia expressed difficulties in understanding the condition as it is non-symptomatic, and can not be identified by body weight or dietary habits. They also questioned the information in media, since it changed frequently, and whether the benefits of life-style changes would be worthwhile. In conclusion, new educational methods are required to improve the dissemination and implementation of scientific achievement in physicians' everyday practice and patients' everyday life.