Document Detail

The accuracy of clinician perceptions of "usual" blood pressure control.
MedLine Citation:
PMID:  18043980     Owner:  NLM     Status:  MEDLINE    
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.
Adam J Rose; Stephanie L Shimada; James A Rothendler; Joel I Reisman; Peter A Glassman; Dan R Berlowitz; Nancy R Kressin
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2007-11-28
Journal Detail:
Title:  Journal of general internal medicine     Volume:  23     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-06     Completed Date:  2008-02-22     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  180-3     Citation Subset:  IM    
Center for Health Quality Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA 01730, USA.
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MeSH Terms
Antihypertensive Agents / administration & dosage*
Clinical Audit
Clinical Competence*
Cohort Studies
Decision Support Systems, Clinical / utilization*
Hospitals, Veterans
Hypertension / drug therapy*
Middle Aged
Quality of Health Care
Reminder Systems*
Treatment Failure
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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