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Unexpected factors predict control of hypertension in a hospital-based homeless clinic
Insights
Homeless patients with hypertension and psychiatric diagnoses showed better blood pressure control. Increased early visit frequency may improve long-term hypertension management in this population.
Area of Science:
- Internal Medicine
- Public Health
- Psychiatry
Background:
- Boston Health Care for the Homeless Program (BHCHP) provides primary care to indigent patients.
- Hypertension (HTN) management remains a challenge in homeless populations despite available services.
- Outpatient clinics at Massachusetts General Hospital (MGH) serve this demographic.
Purpose of the Study:
- To investigate factors influencing long-term hypertension control in homeless patients.
- To analyze the correlation between visit frequency, diagnoses, and blood pressure control.
Main Methods:
- Retrospective chart review of hypertensive patients at MGH clinic (1991-1994).
- Analysis of visit frequency, total visits, and concomitant diagnoses.
- Correlation of these factors with hypertension control (blood pressure < 140/90 mm Hg).
Main Results:
- Overall hypertension control was poor (42%).
- Patients with psychiatric diagnoses had significantly better blood pressure control (OR: 10.2).
- Psychiatric diagnoses correlated with a shorter interval between initial visits, suggesting more frequent early engagement.
Conclusions:
- Concomitant psychiatric diagnoses are associated with improved blood pressure control in homeless patients.
- Increased visit frequency early in treatment may positively impact long-term hypertension management.
- Integrated care addressing both physical and mental health is crucial for this population.
Background:
Boston Health Care for the Homeless Program (BHCHP) physicians conduct a primary care clinic twice a week at Massachusetts General Hospital (MGH). The MGH clinic is part of a city-wide network of BHCHP clinics providing primary care services to indigent patients. Despite this network, long term control of chronic illnesses such as hypertension (HTN) continues to challenge the clinic staff.
Methods:
In an effort to better understand the factors obstructing long term treatment of chronic illness, we conducted a chart review of hypertensive patients seen over a three-year period (January 1991 to March 1994) at the MGH clinic. Frequency of visits, total number of visits and physicians' notes on concomitant diagnoses were analyzed for their correlation to control of hypertension.
Results:
Overall control of hypertension was poor (42%). A greater proportion of patients with a diagnosis of psychiatric illness responded to treatment intended to lower their blood pressure below 140/90 mm Hg than those without such a diagnosis (odds ratio: 10.2). While there was no difference in the total number of clinic visits during the study period, those with a diagnosis of psychiatric illness had a lower average number of days between their first and third visits (52 days vs 108 p = 0.002).
Conclusions:
A greater proportion of patients with concomitant psychiatric diagnoses exhibited blood pressures < or = 140/90 mm Hg than patients without mental illness. The increased frequency of visits at the onset of treatment may confer a positive effect on long term control of HTN among homeless patients attending outpatient hospital-based clinics.