Journal of General Internal Medicine

, Volume 23, Issue 2, pp 180–183

The Accuracy of Clinician Perceptions of “Usual” Blood Pressure Control

  • Adam J. Rose
  • Stephanie L. Shimada
  • James A. Rothendler
  • Joel I. Reisman
  • Peter A. Glassman
  • Dan R. Berlowitz
  • Nancy R. Kressin
Original Article

DOI: 10.1007/s11606-007-0464-1

Cite this article as:
Rose, A.J., Shimada, S.L., Rothendler, J.A. et al. J GEN INTERN MED (2008) 23: 180. doi:10.1007/s11606-007-0464-1
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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.

KEY WORDS

hypertensionambulatory careinformaticsquality of carechronic disease

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Adam J. Rose
    • 1
    • 2
  • Stephanie L. Shimada
    • 1
    • 3
  • James A. Rothendler
    • 1
    • 3
  • Joel I. Reisman
    • 1
  • Peter A. Glassman
    • 4
    • 5
  • Dan R. Berlowitz
    • 1
    • 2
    • 3
  • Nancy R. Kressin
    • 1
    • 2
  1. 1.Center for Health Quality Outcomes and Economic ResearchBedford VA Medical CenterBedfordUSA
  2. 2.Section of General Internal Medicine, Department of MedicineBoston University School of MedicineBostonUSA
  3. 3.Department of Health Policy and ManagementBoston University School of Public HealthBostonUSA
  4. 4.Center for the Study of Healthcare Provider BehaviorVA Greater Los AngelesLos AngelesUSA
  5. 5.David Geffen School of Medicine at UCLALos AngelesUSA