A narrative review of clinical inertia: focus on hypertension

Faria, Claudio; Wenzel, Marie; Lee, Karen W.; Coderre, Karen; Nichols, Jake; Belletti, Daniel

doi:10.1016/j.jash.2009.03.001

Cited by 53 publications

(26 citation statements)

References 39 publications

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“…This was either explicit [17,18] or implicit when Phillips’ definition of clinical inertia was quoted to define therapeutic inertia [11] or physician inertia [19]. A few authors, however, insisted that different terms should mean different things: “ the terms “clinical inertia” and “therapeutic inertia” have been used recently by authors, primarily to attribute to physicians the apparent failure of patients to attain therapeutic blood pressure goals.…”

Section: Resultsmentioning

confidence: 99%

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The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review

et al. 2014

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BackgroundTherapeutic inertia has been defined as the failure of health-care provider to initiate or intensify therapy when therapeutic goals are not reached. It is regarded as a major cause of uncontrolled hypertension. The exploration of its causes and the interventions to reduce it are plagued by unclear conceptualizations and hypothesized mechanisms. We therefore systematically searched the literature for definitions and discussions on the concept of therapeutic inertia in hypertension in primary care, to try and form an operational definition.MethodsA systematic review of all types of publications related to clinical inertia in hypertension was performed. Medline, EMbase, PsycInfo, the Cochrane library and databases, BDSP, CRD and NGC were searched from the start of their databases to June 2013. Articles were selected independently by two authors on the basis of their conceptual content, without other eligibility criteria or formal quality appraisal. Qualitative data were extracted independently by two teams of authors. Data were analyzed using a constant comparative qualitative method.ResultsThe final selection included 89 articles. 112 codes were grouped in 4 categories: terms and definitions (semantics), “who” (physician, patient or system), “how and why” (mechanisms and reasons), and “appropriateness”. Regarding each of these categories, a number of contradictory assertions were found, most of them relying on little or no empirical data. Overall, the limits of what should be considered as inertia were not clear. A number of authors insisted that what was considered deleterious inertia might in fact be appropriate care, depending on the situation.ConclusionsOur data analysis revealed a major lack of conceptualization of therapeutic inertia in hypertension and important discrepancies regarding its possible causes, mechanisms and outcomes. The concept should be split in two parts: appropriate inaction and inappropriate inertia. The development of consensual and operational definitions relying on empirical data and the exploration of the intimate mechanisms that underlie these behaviors are now needed.

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Section: Resultsmentioning

confidence: 99%

“…Gugliano et al stated that: “ Clinical inertia also may apply to the failure of physicians to stop or reduce therapy no longer needed ” [22], a situation for which Rodrigo et al proposed the specific term “therapeutic momentum” [27], although this term had already been defined as synonymous to clinical inertia by Faria et al . [17]. …”

Section: Resultsmentioning

confidence: 99%

The concept and definition of therapeutic inertia in hypertension in primary care: a qualitative systematic review

et al. 2014

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“…Для этого может потребоваться тактичный, но настойчивый опрос больного (и его близких), а также повторное измере-ние АД, позволяющее уменьшить первоначальную реакцию на процедуру измерения АД. Если причиной неадекватного контроля АД будет сочтена неэффек-тивность терапии, то следует безотлагательно модифи-цировать схему лечения, во избежание так называемой клинической инертности -основного фактора неу-довлетворительного контроля АД во всем мире [682,683]. Необходимо помнить о том, что межвизитная вариабельность АД может быть факторов сердечно-сосудистого риска, независимо от достигнутых сред-них значений АД на фоне длительной терапии, поэ- …”

Section: повышение артериального давления на контрольных визитахunclassified

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

Mancia

Fagard²,

Redón³

et al. 2014

Russ J Cardiol

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Авторы/члены рабочей группы: Giuseppe Mancia (сопредседатель; италия)*, Robert Fagard (сопредседатель; бельгия)*, Krzysztof Narkiewicz (координатор секции, Польша), Josep Redón (координатор секции; испания), Alberto Zanchetti (координатор секции, италия), Michael Böhm

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“…reakcję "białego fartucha". Jeśli za przyczynę nieadekwatnej kontroli BP uważa się nieskuteczność terapii, należy bez zbędnego opóźnienia zmodyfikować schemat leczenia, aby uniknąć klinicznej inercji -głównej przyczyny złej kontroli BP na całym świecie [682,683]. Należy zwrócić uwagę na dowody sugerujące, że zmienność wartości BP z wizyty na wizytę może stanowić determinantę ryzyka sercowo-naczyniowego, niezależnie od średnich wartości BP obserwowanych w trakcie długoterminowej terapii, dlatego też pacjenci, u których w czasie kolejnych wizyt wartości BP utrzymują się na stałym poziomie, są lepiej chronieni przed incydentami sercowo-naczyniowymi.…”

Section: Podwyższone Ciśnienie Tętnicze Podczas Wizyt Kontrolnychunclassified