Hypertension Management in a Student-Run Free Clinic: Meeting National Standards?

PURPOSE: Affecting one in three adults, hypertension is one of the most prevalent disorders in the United States. The purpose of this analysis was to evaluate, using national care guidelines and quality standards, the quality of care provided at the Student Family Health Care Center (SFHCC) of the University of Medicine and Dentistry of New Jersey (Newark). METHOD: The authors performed a chart review of all patients seen from June 2008 to June 2009, collecting the following data: age, gender, ethnicity, body mass index, most recent blood pressure measurement, comorbid conditions, number of visits, free medications dispensed, and smoking status. The authors used the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines and Healthy People 2010 quality standards to analyze results. RESULTS: Of the 119 SFHCC patients seen during the study period, 60 had a diagnosis of hypertension. Overall, 30 (50%) of these patients were at target blood pressure. Of the 19 patients (32% of 60) with diabetes and hypertension, 5 (26%) were controlled compared with 25 (61% of 41) with hypertension only. Thirty-eight patients (63%) were taking a thiazide, 42 (70%) were on multidrug regimens, and all 19 of the patients with diabetes (100%) were on an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, as per the JNC 7 guidelines. CONCLUSIONS: SFHCC patients with hypertension received pharmacotherapy as recommended by JNC 7 guidelines and were at the blood pressure goal set by Healthy People 2010

Do State Medical Board Applications Violate the Americans With Disabilities Act?

PURPOSE: To determine whether medical licensing board application questions about the mental or physical health or substance use history of the applicant violate the Americans with Disabilities Act (ADA) of 1990. METHOD: Content analysis of 51 allopathic licensing applications (50 states and District of Columbia) was performed at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in 2005. Questions referencing physical or mental health or substance use were identified by a team of physicians and reviewed and categorized based on the ADA and appropriate case law by legal counsel. RESULTS: Of the 51 applications reviewed, 49 (96%) contained questions pertaining to the physical or mental health or substance use history of the applicant. Thirty-four of the 49 (69%) state medical licensing applications contained at least one likely impermissible or impermissible item based on the ADA and appropriate case law. CONCLUSIONS: Most state medical licensing applications contain questions that ask about the physical or mental health and substance use of physician applicants. Many licensing applications appear to be in violation of the ADA, even 19 years after enactment of the regulation. These questions do not elicit responses by which professional competence can be judged. The presence of these questions on licensing applications may cause physicians to avoid or delay treatment of personal illness