Abstract
BACKGROUND
The term “clinical inertia” is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood.
OBJECTIVE
To describe one potential mechanism for clinical inertia, seen through the lens of clinician responses to a computerized hypertension reminder.
DESIGN
Cohort study.
PARTICIPANTS
A total of 509 hypertensive patients from 2 primary care clinics in urban Veterans Health Administration (VA) Medical Centers. All patients had elevated blood pressure (BP) values that triggered a computerized reminder. Given a set of possible responses to the reminder, clinicians asserted at least once for each patient that medication adjustments were unnecessary because the BP was “usually well controlled”.
MEASUREMENTS
Using recent BP values from the electronic medical record, we assessed the accuracy of this assertion.
RESULTS
In most instances (57%), recent BP values were not well controlled, with the systolic BP (56%) much more likely to be elevated than the diastolic BP (13%). Eighteen percent of recent systolic BP values were 160 mmHg or greater.
CONCLUSIONS
When clinicians asserted that the BP was “usually well controlled”, objective evidence frequently suggested otherwise. This observation provides insight into one potential mechanism underlying clinical inertia.
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Acknowledgments
This research was supported by a grant from the Department of Veterans Affairs Health Services Research and Development Service (TRH01-038, N. Kressin, PI). Drs. Rose and Shimada are supported by grants from the Veterans Administration Department of Academic Affairs. Dr. Kressin is supported by a Research Career Scientist award from the Department of Veterans Affairs, Health Services Research & Development (RCS 02-066-1). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Conflicts of Interest
Dr. Rothendler reports receiving research support from Sanofi-Aventis. Dr. Berlowitz reports receiving research support from Bristol-Myers Squibb. None of the other authors report any potential conflicts of interest.
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Rose, A.J., Shimada, S.L., Rothendler, J.A. et al. The Accuracy of Clinician Perceptions of “Usual” Blood Pressure Control. J GEN INTERN MED 23, 180–183 (2008). https://doi.org/10.1007/s11606-007-0464-1
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DOI: https://doi.org/10.1007/s11606-007-0464-1