Abstract P154: Blood Pressure and Lipid Control Variation in Faculty versus Trainee Clinics

Abstract

Background: Clinics run by trainees are often composed of indigent patients with challenging problems as to implementation of preventive measures. Methods: Charts were selected based on the inclusion of hypertension as a diagnosis; 100 visits were reviewed in each of two groups. The first group (clinic 1) included patients seen by a cardiologist faculty; all patients had insurance. The second group (clinic 2) included visits seen by cardiology fellows, and directly supervised by the same faculty physician; with the majority of these patients lacking insurance. The difference between the groups with regards to age, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and LDL cholesterol were analyzed using Student's t-Test. Results: The mean age of patients in clinic 1 was 62±14 years compared with 52±9 years in clinic 2 (P < 0.01). There was 100% documentation of weight, BP and HR on every visit. The mean weight in clinic 1 was insignificantly lower compared with clinic 2 (202±61 vs 218±60 lbs respectively; P = 0.06). SBP was similar in both clinics (132±18 vs 130±21 mmHg respectively; P = 0.38). HR was lower in clinic 1 compared with clinic 2 (67±10 vs 77±15 BPM respectively; P < 0.01). Lipid profiles, which required a separate visit to the lab and extra charge, were documented in 93% of patients in clinic 1 versus only 34% of patients in clinic 2. LDL cholesterol was lower in clinic 1 compared with clinic 2 (88±34 vs 106±35 mg/dL respectively; P=0.01). While HDL was similar in both clinics (48 ± 14 in clinic 1 versus 46 ± 15 mg/dL in clinic 2; P = NS), non-HDL was lower, at 115 ± 38 in clinic 1 versus 136 ± 40 mg/dL in clinic 2 (P < 0.01). Discussion: Hypertension and dyslipidemia are major health problem. Adequate control of blood pressure and LDL cholesterol correlate with better cardiovascular outcomes. Our data demonstrate that both faculty and fellow clinics achieved mean BP of < 140/90 mmHg, with 100% documentation. However, documentation and control of lipids appear to be more challenging in indigent patients due to the extra burden and cost of undergoing lab tests. Compliance with medications and the prescription of affordable generic, often less potent, lipid-lowering therapy to indigent patients in the fellow clinic may also play a role in the higher LDL levels compared with the faculty clinic. Efforts at improving the adherence of all patients to preventive therapy aimed at achieving guideline-based BP and lipid targets should be included in quality improvement projects during residency training.