Reasons for not intensifying medications: differentiating “clinical inertia” from appropriate care
Open accessAbstract
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.
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Numerous studies have demonstrated the clinical benefits of early achievement of near-normal glycemic control in individuals with type 1 diabetes and type 2 diabetes.
“Numerous studies have demonstrated the clinical benefits of early achievement of nearnormal glycemic control in individuals with type 1 diabetes and type 2 diabetes (77-83).”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [78]
The Introduction (page unavailable) mentions clinical inertia in diabetes, but does not discuss the benefits of early, near-normal glycemic control. Searches for that phrase and for glycemic-control benefits found no passage addressing the claimed benefits in type 1 or type 2 diabetes. (LLM, conf=0.76)
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- Authors
- Safford, M. M., Shewchuk, R., Qu, H., Williams, J. H., Estrada, C. A., Ovalle, F., & Allison, J. J.
- Affiliations
- University of Alabama at Birmingham (US)
- Corresponding author
- Safford, Monika M.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2007-10-24
- Volume
- 22
- Issue
- 12
- Pages
- 1648-1655
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2219839
- OpenAlex
- W2058108073
- Cited by
- 132
- References
- 28
- Citations by year
- 2026: 6 · 2024: 8 · 2023: 5 · 2021: 5 · 2020: 5 · 2019: 8 · 2018: 5 · 2017: 12 · 2016: 9 · 2015: 3 · 2014: 10 · 2013: 7 · 2012: 10
- FWCI
- 15.80
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R18DK065001, R18DK65001-01A2)
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- clinical inertia, medication intensification, uncontrolled hypertension, physician decision-making, quality of care, cardiovascular risk factors, performance indicators, cognitive maps, nominal group technique
- MeSH terms
- Adult, Antihypertensive Agents, Blood Pressure, Drug Utilization, Female, Humans, Hypertension, Male, Middle Aged, Models, Theoretical, Motivation, Physician-Patient Relations, Practice Patterns, Physicians', Primary Health Care, Risk Factors, Guideline Adherence
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