title: Testing for clinical inertia in medication treatment of bipolar disorder.
abstract: Clinical inertia has been defined as lack of change in medication treatment at visits where a medication adjustment appears to be indicated. This paper seeks to identify the extent of clinical inertia in medication treatment of bipolar disorder. A second goal is to identify patient characteristics that predict this treatment pattern.
  
  
  
  Data describe 23,406 visits made by 1815 patients treated for bipolar disorder during the STEP-BD practical clinical trial. Visits were classified in terms of whether a medication adjustment appears to be indicated, and also whether or not one occurred. Multivariable regression analyses were conducted to find which patient characteristics were predictive of whether adjustment occurred.
  
  
  
  36% of visits showed at least 1 indication for adjustment. The most common indications were non-response to medication, side effects, and start of a new illness episode. Among visits with an indication for adjustment, no adjustment occurred 19% of the time, which may be suggestive of clinical inertia. In multivariable models, presence of any indication for medication adjustment was a predictor of receiving one (OR=1.125, 95% CI =1.015, 1.246), although not as strong as clinical status measures.
  
  
  
  The associations observed are not necessarily causal, given the study design. The data also lack information about physician-patient communication.
  
  
  
  Many patients remained on the same medication regimen despite indications of side effects or non-response to treatment. Although lack of adjustment does not necessarily reflect clinical inertia in all cases, the reasons for this treatment pattern merit further examination.
authors.affiliation: Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, United States. Electronic address: hodgkin@brandeis.edu.
authors.forename: Dominic
authors.initials: D
authors.lastname: Hodgkin
authors.affiliation: Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, United States.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Merrick
authors.affiliation: Truven Health Analytics, United States.
authors.forename: Peggy L
authors.initials: PL
authors.lastname: O'Brien
authors.affiliation: Department of Health Care Policy, Harvard Medical School, United States.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: McGuire
authors.affiliation: Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, United States.
authors.forename: Sue
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Harvard Medical School, and Bipolar Clinic and Research Program, Massachusetts General Hospital, United States.
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
authors.affiliation: Department of Psychiatry, Harvard Medical School, and Bipolar Clinic and Research Program, Massachusetts General Hospital, United States.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055815:Young Adult
chemical_list: D018692:Antimanic Agents
keywords: Bipolar disorder; Clinical inertia; Pharmaceuticals; Prescribing decisions