title: Reducing clinical inertia in hypertension treatment: a pragmatic randomized controlled trial.
abstract: Clinical inertia is a major contributor to poor blood pressure (BP) control. The authors tested the effectiveness of an intervention targeting physician, patient, and office system factors with regard to outcomes of clinical inertia and BP control. A total of 591 adult primary care patients with elevated BP (mean systolic BP ≥ 140 mm Hg or mean diastolic BP ≥ 90 mm Hg) were randomized to intervention or usual care. An outreach coordinator raised patient and provider awareness of unmet BP goals, arranged BP-focused primary care clinic visits, and furnished providers with treatment decision support. The intervention reduced clinical inertia (-29% vs -11%, P=.001). Nonetheless, change in BP did not differ between intervention and usual care (-10.1/-4.1 mm Hg vs -9.1/-4.5 mm Hg, P=.50 and 0.71 for systolic and diastolic BP, respectively). Future primary care-focused interventions might benefit from the use of specific medication titration protocols, treatment adherence support, and more sustained patient follow-up visits.
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office 1, 12631 East 17th Avenue, Mailstop B180, Aurora, CO 80045, USA. amy.huebschmann@ucdenver.edu
authors.forename: Amy G
authors.initials: AG
authors.lastname: Huebschmann
authors.forename: Trina
authors.initials: T
authors.lastname: Mizrahi
authors.forename: Alyssa
authors.initials: A
authors.lastname: Soenksen
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Denberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019091:Critical Pathways / Q000639:trends*; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care / Q000639:trends*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents