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Quality Of Care In Student Run Or Free Clinics

2427 words - 10 pages

Introduction
Hypertension is one of the most prevalent disorders in the US, affecting about 1 in 3 adults. Since uncontrolled blood pressure has been linked to consequences such as stroke, congestive heart failure, and chronic kidney disease, it poses considerable risk for a significant portion of the population. According to the American Heart Association, hypertension was responsible for 46,284,000 ambulatory care visits in 2007; and it is estimated that this condition will be either directly or indirectly responsible for $76.6 billion in health care costs in 2010.9 The morbidity and mortality associated with uncontrolled hypertension make initiatives to improve the quality of care in this area important in any outpatient practice.
The LCME encourages medical schools to provide service learning opportunities for students, many medical schools have opted to support student run clinics as part of their service learning and today there are over 110 Student Run Clinics throughout the United States.12 The Student Family Health Care Center (SFHCC) is the student run free clinic at The New Jersey Medical School in Newark, NJ that has been in existence since 1967. The care provided at the clinic includes management of hypertension, diabetes, dyslipidemia, and many other chronic diseases, with hypertension being the most common diagnosis. The patients come from the city of Newark and the surrounding area. Most are uninsured and between the ages of 18 and 65.
In 2003 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) was released. Since then, it has become the most widely accepted guidelines for managing hypertension and is the guideline that is followed at SFHCC.5 The care of hypertensive patients includes regular office visits with a team of students and a volunteer attending physician. This occurs with a 6:1 student team to attending ratio. The clinic also provides some free medications (including most classes of hypertension drugs), counseling, and lifestyle education. Blood pressure is checked at every visit. The purpose of this analysis is to evaluate the quality of care provided at the Student Family Health Care Center, and to compare the blood pressure goal achievement in our patients to that achieved nationally in a similar patient population.
Methods
A chart review was performed for all patients seen from June 2008 to June 2009, 120 charts, using a data extraction form. We collected the following: diagnosis of hypertension, most recent patient blood pressure measurement, comorbid conditions, ethnicity, medications prescribed, free medications dispensed, BMI, age, and smoking status. Sixty patients with a diagnosis of hypertension were identified and included in the study. Each chart was further reviewed to identify the actual blood pressure measurements and medication management. According to the JNC 7 guideline, in those over age...

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