221 - KNOWLEDGE TO ACTION: IMPLEMENTATION OF A KNOWLEDGE TRANSLATION STRATEGY TO IDENTIFY AND TREAT FAMILIAL HYPERCHOLESTEROLEMIA

Background: Familial Hypercholesterolemia (FH) causes progressive atherosclerosis from infancy. Left untreated, FH causes premature cardiovascular events, often in young adulthood. Despite Canadian Cardiovascular Society (CCS) guidelines recommending universal screening for FH in children, over 90% of cases in Canada remain undiagnosed. A survey of primary care physicians revealed over 85% were unaware of these guidelines.

We hypothesized that a Knowledge Translation (KT) intervention could foster confidence and improve utilization of guideline recommendations for screening, diagnosis, and treatment of FH amongst family physicians and pediatricians in British Columbia (BC).

METHODS AND RESULTS: We developed an interactive Continuing Medical Education (CME) course featuring case-based learning and audience polling. The course was collaboratively designed with guideline authors, KT experts, and pediatric cardiologists based on validated frameworks including the Theoretical Domains Framework, AIMD, and the Behaviour Change Wheel. The course was delivered online and in-person in partnership with the BC Pediatric Society, BC Children’s Hospital, UBC Faculty of Medicine, and the Rural Coordination Centre of BC. Over 100 physicians have attended the course, representing all 5 health authorities in BC.

Pre-CME, 67% of physicians lacked confidence managing pediatric dyslipidemias, 61% were unfamiliar with CCS guidelines, and 68% expressed discomfort prescribing statins to children. However, confidence in screening and diagnosing FH increased significantly post-intervention (p < 0.01) (Figure 1). Physicians were also significantly more likely to screen for FH post-CME (p < 0.05) (Figure 2). Physicians’ intent to screen increased by 37% (42% to 79%) for children with chronic cardiometabolic conditions, by 32% (47% to 79%) for children with at-risk race/ethnicity, and by 14% (79% to 93%) for children with a family history of early cardiovascular events. Furthermore, absolute rates of correctly diagnosing a hypothetical patient with FH increased by 24% (from 33% to 57%). In this scenario, physician management strategies marginally improved post-course, including statin prescriptions (53% to 64%), genetic testing (40% to 57%), and referrals to lipid specialists (67% to 79%). The course was well-received, with 98% learning something new, 85% finding it effective, and 75% planning to change their practices accordingly.


Conclusion: A theoretically based KT initiative is effective at improving physicians' confidence and adherence to guidelines for screening and diagnosis of FH. Given that there were not substantial changes to treatment practices, we speculate that involvement of lipid specialists for children with FH is important. Widespread implementation of this KT initiative has potential to result in earlier referral of patients to lipid specialists who can optimize their care.