title: Hypertension management in health care for the homeless clinics: results from a survey.
abstract: BACKGROUND
  With the exception of alcohol abuse, hypertension is the most common chronic physical health problem encountered among homeless persons. The material conditions of homelessness greatly complicate the management of this disorder. Some of the complications and their solutions are discussed here, based on the experiences of health clinics for the homeless in large US cities.
  
  
  METHODS
  In 1988, the Stewart B. McKinney Homeless Assistance Act established health care clinics for homeless persons in 108 cities. We surveyed medical directors in these clinics, asking about the management of hypertension in this difficult-to-treat population; 65 responded.
  
  
  RESULTS
  Comparisons between our survey data and those obtained in two recent surveys of clinicians in "normal" clinical practice provide interesting lessons in how medical practice is adapted to respond to the unique needs and problems of the urban homeless. Although therapeutic goals are similar, the means chosen to achieve them often are not.
  
  
  CONCLUSIONS
  The treatment of homeless hypertensives illustrates the problems inherent in strict biomedical models of disease and its alleviation. Preferred treatments, course of disease, and success of intervention are powerfully affected by social factors.
authors.affiliation: Department of Sociology, Tulane University, New Orleans, LA 70118-5698.
authors.forename: K
authors.initials: K
authors.lastname: Kinchen
authors.forename: J D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000554:Ambulatory Care Facilities; D006703:Ill-Housed Persons; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D016312:Treatment Refusal; D014481:United States