"Ecologic niche" of undetected hypertensives at increased risk.

The "ecologic niche" where large numbers of young black hypertensive males can be found is in the emergency clinics of our public general hospitals. Unfortunately, present medical practices in these clinics do not adequately identify the hypertensive patient. Because educational measures are unlikely to change this deficiency, the present organization and management of the emergency clinics must be changed to give these hypertensive patients effective treatment. As the public becomes more aware of the successes in treating mild hypertension, we can anticipate that health care practices of both hypertensive patients and their physicians will improve.

Relocating primary care patients from tertiary hospital to neighborhood health centers.

A national commission recently recommended that public general hospitals assume the initiative in arranging neighborhood-based primary care. A survey of medically underserved census tracts conducted in Houston 11 years ago revealed that 80% of residents interviewed stated that if neighborhood clinics were developed they would use them. After ten years' experience with eight neighborhood clinics, 300,000 ambulatory visits continue to be made annually to tertiary care hospitals, and more than 19.7 +/- 2.1% of 90,000 yearly visits to the emergency room are for primary care problems, though a neighborhood clinic is less than half this distance from the patient's home. Therefore, before communities embark on implementing the commission's recommendations, they should consider carefully the health care attitude, knowledge, and utilization behavior of their prospective patients.