| The accuracy of clinician perceptions of "usual" blood pressure control. | |
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MedLine Citation:
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PMID: 18043980 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Adam J Rose; Stephanie L Shimada; James A Rothendler; Joel I Reisman; Peter A Glassman; Dan R Berlowitz; Nancy R Kressin |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, U.S. Gov't, Non-P.H.S. Date: 2007-11-28 |
Journal Detail:
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Title: Journal of general internal medicine Volume: 23 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-02-06 Completed Date: 2008-02-22 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 180-3 Citation Subset: IM |
Affiliation:
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Center for Health Quality Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA 01730, USA. adamrose@bu.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Antihypertensive Agents / administration & dosage* Clinical Audit Clinical Competence* Cohort Studies Decision Support Systems, Clinical / utilization* Female Hospitals, Veterans Humans Hypertension / drug therapy* Male Middle Aged Quality of Health Care Reminder Systems* Treatment Failure |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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