You are working in a free clinic staffed by student volunteers. The clinic has students from multiple disciplines, including medical, nursing, nutrition, social work, and pharmacy students, who all work side-by-side to provide care for uninsured
You are working in a free clinic staffed by student volunteers
Week 4 DQ
• Post your initial response to the Discussion Area by Day 3. • Please make sure you are using scholarly references and they should not be older than 5 years. Your posts/references must be in APA format.
You are working in a free clinic staffed by student volunteers. The clinic has students from multiple disciplines, including medical, nursing, nutrition, social work, and pharmacy students, who all work side-by-side to provide care for uninsured or underinsured residents of the local urban underserved community.
Dr. Gabriela Medel, your supervising family medicine preceptor, also, discusses your next patient with you and Carla George, a nursing student with whom you are working.
Dr. Medel tells you and Carla, “Mr. Jose Martin is a 54-year-old male who is new to the clinic and has not received medical care in over 10 years.”
Carla offers to take Mr. Martin’s blood pressure.
Carla reports to you and Dr. Medel, “Mr. Martin’s blood pressure is 150/85 mmHg in his right arm, and his pulse is 80 beats per minute. So it appears that we will be considering whether Mr. Martin has hypertension or not.”
You recall that you recently read an article about hypertension, and that guidelines for its definition and treatment have changed over time.
You mention this, and Dr. Medel responds, “For many years, we defined blood pressures between 120-139/80-89 as ‘prehypertensive.’ Blood pressures in this range were recognized to put people at higher risk of cardiovascular events, also physicians were supposed to give patients with prehypertension guidance on making changes to their diet and exercise to prevent the development of hypertension.
“Unfortunately, physicians and patients often disregarded this label. More recent guidelines, from the American College of Cardiology (ACC). Also, the American Heart Association (AHA). Now define blood pressures of 130/80 or greater as hypertensive. Which could push physicians and patients to focus more on the importance of lifestyle changes.”
You ask Dr. Medel, “Am I recalling correctly that the AAFP (American Academy of Family Physicians) did not endorse these guidelines? Further, how do you decide which guidelines to follow in your practice if organizations disagree?”
Dr. Medel replies, “That is one of the challenging things about clinical practice. After reviewing these guidelines, I chose to adopt them into my clinical practice. The AAFP pointed out that these guidelines did not fully address the risk of harms with lower blood pressure goals, and so I am more cautious about the potential downsides of lower blood pressures than the ACC/AHA guidelines suggest (especially in groups such as older adults, who are particularly at risk of adverse events from medications). I am also always cautious about conflicts of interest, which was another concern of the AAFP, and will be looking out for further studies that may change these recommendations once again.”