The accuracy of clinician perceptions of "usual" blood pressure control.
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.


METHODS
Cohort study.


METHODS
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".


METHODS
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.
Center for Health Quality Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA 01730, USA. adamrose@bu.edu
Adam J
AJ
Rose
Stephanie L
SL
Shimada
James A
JA
Rothendler
Joel I
JI
Reisman
Peter A
PA
Glassman
Dan R
DR
Berlowitz
Nancy R
NR
Kressin
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D054869:Clinical Audit; D002983:Clinical Competence; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D017010:Reminder Systems; D017211:Treatment Failure
D000959:Antihypertensive Agents