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Decline in cholesterol testing dangerous

Nearly half of Australians on stable lipid-lowering cholesterol treatment are not having enough high-density lipoprotein tests, research has revealed.

The new figures, published in BMJ Open, suggest that many Australians may be at risk of developing cardiovascular disease because health checks were not in line with national guidelines.

As part of the study, a team of researchers from Western Sydney University, University of Sydney, University of Adelaide and Capital Markets CRC analysed publicly available patient records in the Medicare Benefits Scheme and Pharmaceutical Benefits Scheme databases.

Researchers collated records of 2.4 million adult Australians on prescription medication to lower cholesterol medication over a seven-year period.

Results showed that 49 per cent of patients on cholesterol medication did not have the recommended annual HDL-C test in a given year, and 19 per cent of the same patients had more testing than necessary.

Western Sydney University’s Dr Evan Atlantis said he was concerned that one-fifth of patients were receiving unnecessary tests, while more than half were not being sufficiently monitored.

“Cholesterol tests are being administered in a haphazard manner – with some patients being tested too frequently and others not enough,” Atlantis said.

The paper put forward several possible explanations for this finding, and Atlantis said it was most plausible that there was a deficiency in community care, and the fact it was common for patients to see multiple practitioners at once.

“If there is no designated ‘medical home’ for the patient, it is not clear who bears the responsibility for managing cardiovascular risk. In this scenario, it is not surprising that many individuals miss their annual cholesterol tests,” he said.

“Another contributing factor may be the lack of continuity in medical records. It is entirely possible that practitioners are not aware that some of their patients are not on cholesterol medications and therefore do not take the recommended action in ordering tests.

“Another possibility is that medical practitioners are making a clinical choice not to follow the current guidelines on blood cholesterol monitoring.”

Based on the findings, Atlantis and co-researcher Dr Katy Bell from the University of Sydney conclude that the “widespread non-adherence” may be evidence the guidelines should be reviewed.

“If there is high level evidence that the recommended frequency of tests leads to improved health outcomes, then the potential underutilisation of these tests in Australia warrants further attention,” Bell said.

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