Nonadherence, Clinical Inertia, or Therapeutic Inertia?

Abstract

in which certain therapies have adequate, even overwhelming if not unequivocal, evidence of effectiveness. 5 Clinical inertia occurs, for example, when the patient fails to attain a biomarker goal (e.g., blood pressure less than 140/90 millimeters of mercury [mm Hg]) due at least in part to failure to intensify pharmacotherapy through upward dosing and/or addition of drugs to the therapeutic regimen. O'Connor et al. attributed clinical inertia 50% to physician factors, 30% to patient factors, and 20% to office-system factors. 4 We might consider the latter category even more broadly to include all health-system factors (Table 1). While we are uncertain about the relative weights for these 3 categories of factors that contribute to clinical inertia, we propose that this conceptual model, including relative weights, should become a focal point in research in nonadherence and failure to attain biomarker and other clinical goals.While acknowledging access, cost, and patient nonadherence, Phillips et al. emphasized the role of clinicians when they wrote in 2001 that clinical inertia occurs when health care providers recognize the problem (failure to attain therapeutic targets in patients with hypertension, dyslipidemia, or diabetes) but fail to act (to initiate or intensify therapy). Clinical inertia is more than failure to act, and it has been shown that other factors such as clinician communication affect adherence. Zolnierek and DiMatteo (2009) discovered in a meta-analysis of 127 studies that the odds of adherence for patients whose physicians had been trained in communication skills were 1.62 times those of patients whose physicians did not receive communication training.

Factors associated with clinical inertia: an integrative review

“…Clinical inertia arises in the context of evidence-based practices, and may be identified if three conditions are precisely defined: recognized clinical outcomes (goals or targets); a recommended therapy that can be measured; and a window of time appropriate for initiation or intensification of treatment 2,5. It has been argued, however, that such standardized definitions of clinical inertia based on target, time frame, and the decision to intensify therapy (or not) are not sufficient to determine whether individual decisions to increase, decrease, or maintain therapy might be appropriate for a patient 9,10. Indeed, in order to adequately assess clinical inertia, it is necessary to define intermediate outcomes that incorporate information on and justification of decisions relating to treatment 11.…”

Rescue therapy within the UK Cystic Fibrosis Registry: An exploration of predictors of intravenous antibiotic use amongst adults with CF

“…If objective nebulizer adherence is satisfactory, another cause for insufficient utilization of preventative therapy to consider is ‘therapeutic inertia’. Therapeutic inertia refers to the under‐prescription of efficacious treatments . In CF, the prescription of inhaled therapies have increased since mid 1990s .…”

Diabetes Research and Care Through the Ages

“…In order to facilitate this decision, the guidelines list the characteristics of each medication including side effects and cost, and the health care provider is expected to make a choice that would be most suited for patient comorbidities and health care circumstances. This can be confusing and contributes to the clinical inertia characteristic of the usual management of T2D (33). Rather than revisiting this topic in this narrative, it is felt we can all agree that we are now in an era of diabetes therapy where the first choice of medications should provide effective glucose-lowering without weight gain or hypoglycemia.…”