Work-site as locus for hypertension care.

The widespread failure to control high blood pressure (BP) reflects a mismatch between therapist, treatment and patient. Occupationally based programmes which have transformed the method of care, as well as its relationship to the patient, have achieved signal success. Examination of the specific impact of locus of treatment reveals a small but measurable benefit of on-site therapy. Closer inspection reveals that it is the context in which the care is rendered rather than its physical location that is responsible for the satisfactory outcomes achieved. The locus of care, however, cannot be separated from its environment. Occupationally based programmes that are patient-centred, supportive and provide appropriate intervention succeed 'on' or 'off' site. The lesson for conventional sources of care, wherever they exist, is to reorient the process of care and its relation to the patient to over come the disincentives to persistence in successful care.