title: Clinical inertia in poorly controlled elderly hypertensive patients: a cross-sectional study in Spanish physicians to ascertain reasons for not intensifying treatment.
abstract: BACKGROUND
  Clinical inertia, the failure of physicians to initiate or intensify therapy when indicated, is a major problem in the management of hypertension and may be more prevalent in elderly patients. Overcoming clinical inertia requires understanding its causes and evaluating certain factors, particularly those related to physicians.
  
  
  OBJECTIVE
  The objective of our study was to determine the rate of clinical inertia and the physician-reported reasons for it.
  
  
  METHODS
  An observational, cross-sectional, multi-center study was carried out in a primary care setting. We included 512 physicians, with a consecutive sampling of 1,499 hypertensive patients with clinical inertia.
  
  
  METHODS
  Clinical inertia was defined when physicians did not modify treatment despite knowing that the therapeutic target had not been reached. Clinical inertia was considered to be justified (JCI) when physicians provided an explanation for not intensifying treatment and as not justified (nJCI) when no reasons were given.
  
  
  RESULTS
  JCI was observed in 30.1 % (95 % CI 27.8-32.4) of patients (n = 451) and nJCI in 69.9 % (95 % CI 67.6-72.2) (n = 1,058). JCI was associated with higher blood pressure (BP) values (both systolic and diastolic) and diabetes (p = 0.012) than nJCI. nJCI was associated with patients having an isolated increase of systolic or diastolic or high borderline BP values or cardiovascular disease.
  
  
  CONCLUSIONS
  Physicians provided reasons for not intensifying treatment in poorly controlled patients in only 30 % of instances. Main reasons for not intensifying treatment were borderline BP values, co-morbidity, suspected white coat effect, or perceived difficulty achieving target. nJCI was associated with high borderline BP values and cardiovascular disease.
authors.affiliation: Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Ctra. De Valencia N332 Km 87, San Juan, 03550, Alicante, Spain. atencion.primaria@umh.es
authors.forename: Vicente
authors.initials: V
authors.lastname: Gil-Guillén
authors.forename: Domingo
authors.initials: D
authors.lastname: Orozco-Beltrán
authors.forename: Concepción
authors.initials: C
authors.lastname: Carratalá-Munuera
authors.forename: Emilio
authors.initials: E
authors.lastname: Márquez-Contreras
authors.forename: Ramón
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.forename: Richard
authors.initials: R
authors.lastname: Cooper
authors.forename: Salvador
authors.initials: S
authors.lastname: Pertusa-Martínez
authors.forename: Salvador
authors.initials: S
authors.lastname: Pita-Fernandez
authors.forename: Diego
authors.initials: D
authors.lastname: González-Segura
authors.forename: José Luis
authors.initials: JL
authors.lastname: Martin-de-Pablo
authors.forename: Vicente
authors.initials: V
authors.lastname: Pallarés
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández
authors.forename: Josep
authors.initials: J
authors.lastname: Redón
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents