title: Review: clinical inertia in the management of chronic obstructive pulmonary disease.
abstract: Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death in the United States. Despite clinical practice guidelines endorsed by national organizations, the management of COPD deviates from guideline recommendations. Patients with COPD are frequently underdiagnosed and misdiagnosed, due in large part to the lack of spirometry testing. When diagnosed, about one third of patients are not receiving any COPD-related drug therapy. Factors that contribute to suboptimal management include provider, patient, and system factors. Physician factors such as understanding and attitude toward the disease, and awareness of guidelines, may affect appropriate management of COPD. Patient factors include medication non-adherence, understanding of the disease, severity of their symptoms, and access to medications. System factors such as insurance coverage may limit aspects of COPD care. To overcome clinical inertia, a multifaceted approach is required. Provider and patient education, the use of health informatics, changes in provider work-flow and the recent development of performance measures, such as the use of spirometry in patients with COPD, can improve the delivery of recommended care for COPD patients.
authors.affiliation: PosiHealth, Inc., Ellicott City, Maryland, USA. cCooke@PosiHealth.com
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Cooke
authors.forename: Michelle
authors.initials: M
authors.lastname: Sidel
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Belletti
authors.forename: Anne L
authors.initials: AL
authors.lastname: Fuhlbrigge
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002983:Clinical Competence; D003951:Diagnostic Errors; D019983:Guideline Adherence / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines; D008403:Mass Screening; D055118:Medication Adherence; D008508:Medication Errors; D036501:Metered Dose Inhalers / Q000706:statistics & numerical data; D058007:Physicians, Primary Care; D022242:Pneumococcal Vaccines; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000628:therapy*; D012720:Severity of Illness Index; D016540:Smoking Cessation; D013147:Spirometry / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines