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    Reasons for not intensifying medications: differentiating "clinical inertia" from appropriate care

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    Authors
    Safford, Monika M.
    Shewchuk, Richard M.
    Qu, Haiyan
    Williams, Jessica H.
    Estrada, Carlos A.
    Ovalle, Fernando
    Allison, Jeroan J.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2007-10-25
    Keywords
    Adult
    Antihypertensive Agents
    Blood Pressure
    Drug Utilization
    Female
    Guideline Adherence
    Humans
    Hypertension
    Male
    Middle Aged
    Models, Theoretical
    Motivation
    *Physician's Practice Patterns
    Physician-Patient Relations
    Primary Health Care
    Risk Factors
    Bioinformatics
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1007/s11606-007-0433-8
    Abstract
    BACKGROUND: "Clinical inertia" has been defined as inaction by physicians caring for patients with uncontrolled risk factors such as blood pressure. Some have proposed that it accounts for up to 80% of cardiovascular events, potentially an important quality problem. However, reasons for so-called clinical inertia are poorly understood. OBJECTIVE: To derive an empiric conceptual model of clinical inertia as a subset of all clinical inactions from the physician perspective. METHODS: We used Nominal Group panels of practicing physicians to identify reasons why they do not intensify medications when seeing an established patient with uncontrolled blood pressure. MEASUREMENTS AND MAIN RESULTS: We stopped at 2 groups (N = 6 and 7, respectively) because of the high degree of agreement on reasons for not intensifying, indicating saturation. A third group of clinicians (N = 9) independently sorted the reasons generated by the Nominal Groups. Using multidimensional scaling and hierarchical cluster analysis, we translated the sorting results into a cognitive map that represents an empirically derived model of clinical inaction from the physician's perspective. The model shows that much inaction may in fact be clinically appropriate care. CONCLUSIONS/RECOMMENDATIONS: Many reasons offered by physicians for not intensifying medications suggest that low rates of intensification do not necessarily reflect poor quality of care. The empirically derived model of clinical inaction can be used as a guide to construct performance measures for monitoring clinical inertia that better focus on true quality problems.
    Source
    J Gen Intern Med. 2007 Dec;22(12):1648-55. Epub 2007 Oct 24. Link to article on publisher's site
    DOI
    10.1007/s11606-007-0433-8
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47694
    PubMed ID
    17957346
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/s11606-007-0433-8
    Scopus Count
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    Population and Quantitative Health Sciences Publications

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