Hypertension Outcomes at a Student-Run Clinic for the Uninsured

Abstract

Background: Hypertension is a potent risk factor for cardiovascular disease in the uninsured. Medical student-run free clinics are increasingly managing chronic conditions like hypertension, but there are limited data addressing the quality of care such clinics provide. This study evaluates hypertension outcomes at the East Harlem Health Outreach Partnership (EHHOP), a student-run clinic affiliated with Mount Sinai School of Medicine, in comparison to publicly and privately insured populations.
Methods: A retrospective cohort analysis of EHHOP patients with hypertension (N=65) was performed. Results were compared to New York State Medicaid (N=10,117) and commercial insurance patients (N=7,669) with hypertension. The primary outcome measure was percent of patients controlled <140/90 mmHg. Secondary analyses in the EHHOP sample evaluated control below individual JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) goal, blood pressure trends, and factors associated with control.
Results: At their most recent visits, 57% of EHHOP, 58% of Medicaid, and 59% of commercial insurance patients were controlled <140/90 mmHg. In the EHHOP sample, 47.7% (31/65) of patients met their individual goal, including 35.7% (10/28) of diabetics. The mean change in blood pressure at EHHOP was -12.3 mmHg systolic (95% CI 5.7-18.9; p<0.01) and -6.8 mmHg diastolic (95% CI 2.9-10.5; p<0.01) over a mean follow-up of 16.2 months.
Conclusions: Though limited by small sample size, results suggest that hypertension control at EHHOP is equivalent to other care settings. Results also demonstrate that EHHOP patients with hypertension experience clinically meaningful reductions in blood pressure. The study supports student-run free clinics as a model for delivering quality healthcare to vulnerable populations.