title: General practitioners' justifications for therapeutic inertia in cardiovascular prevention: an empirically grounded typology.
abstract: To construct a typology of general practitioners' (GPs) responses regarding their justification of therapeutic inertia in cardiovascular primary prevention for high-risk patients with hypertension.
  
  
  
  Empirically grounded construction of typology. Types were defined by attributes derived from the qualitative analysis of GPs' reported reasons for inaction.
  
  
  
  256 GPs randomised in the intervention group of a cluster randomised controlled trial.
  
  
  
  GPs members of 23 French Regional Colleges of Teachers in General Practice, included in the EffectS of a multifaceted intervention on CArdiovascular risk factors in high-risk hyPErtensive patients (ESCAPE) trial.
  
  
  
  The database consisted of 2638 written responses given by the GPs to an open-ended question asking for the reasons why drug treatment was not changed as suggested by the national guidelines. All answers were coded using constant comparison analysis. A matrix analysis of codes per GP allowed the construction of a response typology, where types were defined by codes as attributes. Initial coding and definition of types were performed independently by two teams.
  
  
  
  Initial coding resulted in a list of 69 codes in the final codebook, representing 4764 coded references in the question responses. A typology including seven types was constructed. 100 GPs were allocated to one and only one of these types, while 25 GPs did not provide enough data to allow classification. Types (numbers of GPs allocated) were: 'optimists' (28), 'negotiators' (20), 'checkers' (15), 'contextualisers' (13), 'cautious' (11), 'rounders' (8) and 'scientists' (5). For the 36 GPs that provided 50 or more coded references, analysis of the code evolution over time and across patients showed a consistent belonging to the initial type for any given GP.
  
  
  
  This typology could provide GPs with some insight into their general ways of considering changes in the treatment/management of cardiovascular risk factors and guide design of specific physician-centred interventions to reduce inappropriate inaction.
  
  
  
  NCT00348855.
authors.affiliation: Department of General Practice, EES Research Team, University of Tours. Faculté de Médecine, Tours, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lebeau
authors.affiliation: Department of General Practice, University of Tours. Faculté de Médecine, Tours, France.
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Cadwallader
authors.affiliation: Department of General Practice, University of Auvergne. Faculté de Médecine, Clermont-Ferrand, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Vaillant-Roussel
authors.affiliation: Department of General Practice, University of Tours. Faculté de Médecine, Tours, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Pouchain
authors.affiliation: Centre Hospitalier de Vendôme, Vendôme, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Yaouanc
authors.affiliation: Department of General Practice, REMES Research Team, University Paris Diderot. 16 rue Henri Huchard, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Aubin-Auger
authors.affiliation: Department of General Practice, University Paris 13. UFR SMBH, Bobigny, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Mercier
authors.affiliation: Department of Public Health, EES Research team University of Tours. Faculté de Médecine, Tours, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Rusch
authors.affiliation: Department of Primary and Interdisciplinary Care, University of Antwerp. Campus Drie Eiken, Antwerpen, Belgium.
authors.forename: Roy
authors.initials: R
authors.lastname: Remmen
authors.affiliation: Department of Primary and Interdisciplinary Care, University of Antwerp. Campus Drie Eiken, Antwerpen, Belgium.
authors.forename: Etienne
authors.initials: E
authors.lastname: Vermeire
authors.affiliation: Department of Primary and Interdisciplinary Care, University of Antwerp. Campus Drie Eiken, Antwerpen, Belgium.
authors.forename: Kristin
authors.initials: K
authors.lastname: Hendrickx
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002983:Clinical Competence; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention / Q000379:methods / Q000592:standards
chemical_list: D000959:Antihypertensive Agents
keywords: PRIMARY CARE; QUALITATIVE RESEARCH