Recipe (edited for clarity):

Contemporary Pediatrics®:

Hi, thanks for joining us. I’m Joshua Fitch, editor Contemporary Pediatrics®.

Dave Little, MD, MS:

And I’m Dave Little. I am a family physician by training and a member of the Epic Research team here at Epic Electronic Health Record Corporation.

Contemporary Pediatrics®:

Dr. Little thank you very much for taking the time. Dr. Little is here to discuss lipid screening and how it may play a role in childhood obesity. First, can you explain what these lipids are and how screening for them and children with obesity can play a role in treatment?

Little:

Sure, lipid is the medical word for cholesterol, and I think most of us adults are familiar with cholesterol and that it’s bad and contributes to strokes and heart attacks. What people are less aware of is that there are recommendations that our children should also be screened. Our children should all be screened between the ages of 9 and 11, and in children with additional risk factors, diabetes or high blood pressure, or obesity, or a strong family history of heart disease at a young age, children are at risk Groups should be screened his earlier at the age of 2-8 years.

Contemporary Pediatrics®:

According to your research, some of these screenings are not done even if there is a risk assessment for obesity, right? Why is that the case?

Little:

The study came from the Epic Research database called Cosmos, and Cosmos is a de-identified database that aggregates clinical data from hundreds of healthcare facilities that use Epic Electronic Health Record software. We make it available to support medical research and healthcare decision-making. Currently, we have 190 million patients in the Cosmos database, and that was the group we studied in our analysis. When we looked at the high-risk kids, from 2 to 8 years old that we talked to—there were about 165,000 patients that we looked at—we found that only about 5 and a half percent of them were getting screened. The older kids from 9 to 11, we looked at a population of 237,000 kids and found that only 18.8% of them were getting screened, so you’re absolutely right that a lot of the screenings that need to happen, aren’t happening. Now your question is why these screenings are not happening, we don’t know from our data. But we can think about what happens in a typical office visit. Providers may not be aware, patients and families may not be aware. These tests may not be routinely reimbursed by payers. These are all possibilities. We have recommendations available. The [Centers for Disease Control and Prevention] (CDC) has released the recommendations. Leading pediatric charity Bright Futures has also released these recommendations. So I don’t think in our data we have an answer as to why these screenings are not happening. We have ways to leverage the electronic medical record to improve these screenings through a process we call clinical decision support. Clinical decision support is guidance provided to clinicians within a patient record. For example, if we have information in a patient’s medical record that this patient was at high risk, the doctor might get a message, “hey, it would be a good idea to do a cholesterol screening on this patient.” It is the job of Epic and other health registries and developers to make these things happen. Another thing I would recommend to improve screening rates is better public health education. Parents all know their children need shots. It’s usually the parents who are starting the “hey, when are my kids’ shots? When can I get my next appointment?” Since the parents drive it, and since the clinical decision support is directed not only to the providers, but also to the patients and not least, the parents, then the parents will be the ones who drive the providers to ensure that these screenings are done.

Contemporary Pediatrics®:

Thank you, Dr. Little. Once the screenings are done, what are the next steps for healthcare providers? Even for these children at risk? They are the ones being looked at, right? So how, how does the treatment process begin after screening is completed?

Little:

Once the screening is complete, depending on the severity of the hypercholesterolemia, the process will in most cases begin with counseling for the child and their family about better diet and more and better exercise. Especially in this day and age, people need to pay attention to screen time. Kids these days are spending a lot more time in front of their screens, and a lot less physical activity, and a lot of that was exacerbated by the pandemic when we were all locked in and the habits that people develop not just kids, but the habits that we all developed in response for being shut up throughout the pandemic, have passed over. So, there are a lot of health behaviors that would be the first line of treatment for these young people who have cholesterol problems.

Contemporary Pediatrics®:

Why are these screenings necessary for these at-risk children? And again, can you just touch on the direct impact that screening will have?

Little:

You know, we screened kids for cholesterol because we want kids to have a healthy life from age 2 or age 8 or age 9 or whenever they get their first screening in their lifetime. The earlier you can introduce and reinforce positive health behaviors in children, it will make all the difference in the world. The sooner you can get your cholesterol levels under control, the more impact you have on your long-term risk of premature heart attack, premature stroke, and other visible complications of high cholesterol. So, the sooner you get over these things, medically, the better, and behaviorally and socially, the better, too. So on both of these fronts, medical and behavioral, it’s a great idea to get kids started on a healthy lifestyle as early as possible.

Contemporary Pediatrics®:

Thank you, Dr. Little. Anything else you’d like to add about these shows?

Little:

First of all, thank you for putting the words out there, because I think awareness is kind of the gap that we’ve seen in our research. Let’s get the word out to providers through broadcasts like this and work to get the word out to the population and to their parents and kids to start checking those cholesterol numbers. In fact, the more patients and families not only drive the solutions but ask the questions, the better it will be in the long run.

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