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Clinical inertia: a common barrier to changing provider prescribing behavior

Roumie CL, Elasy TA, Wallston KA, Pratt S, Greevy RA, Liu X, Alvarez V, Dittus RS, Speroff T. Clinical inertia: a common barrier to changing provider prescribing behavior. Joint Commission Journal on Quality and Patient Safety. 2007 May 1; 33(5):277-85.

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Abstract:

BACKGROUND: A cross-sectional content analysis nested within a randomized, controlled trial was conducted to collect information on provider responses to computer alerts regarding guideline recommendations for patients with suboptimal hypertension care. METHODS: Participants were providers who cared for 1,017 patients with uncontrolled hypertension on a single antihypertensive agent within Veterans Affairs primary care clinics. All reasons for action or inaction were sorted into a framework to explain the variation in guideline adaptation. RESULTS: The 184 negative provider responses to computer alerts contained explanations for not changing patient treatment; 76 responses to the alerts were positive, that is, the provider was going to make a change in antihypertensive regimen. The negative responses were categorized as: inertia of practice (66%), lack of agreement with specific guidelines (5%), patient-based factors (17%), environmental factors (10%), and lack of knowledge (2%). Most of the 135 providers classified as inertia of practice indicated, "Continue current medications and I will discuss at the next visit." The median number of days until the next visit was 45 days (interquartile range, 29 to 78 days). DISCUSSION: Clinical inertia was the primary reason for failing to engage in otherwise indicated treatment change in a subgroup of patients. A framework was provided as a taxonomy for classification of provider barriers.





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