Abstract 11930: Using Implementation Science to Develop a Familial Hypercholesterolemia Screening Program in Primary Care: The CARE-FH Study

Abstract

Introduction: Cholesterol screening in primary care is necessary to identify children and young adults with familial hypercholesterolemia (FH). Research question: What is the current state of FH screening and what barriers exist to screening? What implementation strategies informed by human centered design can be utilized to improve FH screening in primary care? Aim: We partnered with key stakeholders to sequentially define the current state of FH screening, assess acceptability, feasibility, and appropriateness of implementing an FH screening program, and select clinically usable strategies to be deployed as a package in the CARE-FH clinical trial. Methods: Data on the perspectives of primary care clinicians to implement an FH screening program were collected. Methods informed by implementation science and human centered design for data collections included: contextual inquiries, surveys, and deliberative engagement sessions. Results: Current screening for FH occurred rarely, and then only after a cardiovascular event or sometimes in primary care due to a family history of high cholesterol or early heart attack. Surveys of primary care clinicians suggested FH screening in primary care was acceptable, appropriate, and feasible. Reported and observed barriers and facilitators to screening identified where improvement in FH screening and diagnosis could occur. Data from the current state and perspectives on FH screening were used to identify multilevel implementation strategies that were presented to and modified by clinician and healthcare stakeholders. This package of strategies was pilot tested in one primary care clinic and further refined to a final implementation strategy package to be tested in a geographical cluster randomized stepped wedge trial. Conclusion: We created an implementation strategy package to be deployed and evaluated in the CARE-FH clinical trial to improve FH awareness, identification, and initiate guideline-based care.