Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia.
Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.
Department of Psychology, University of Quebec at Montreal (UQAM), Montreal, Quebec H3C 3P8, Canada.|Montreal Behavioural Medicine Centre (MBMC), Research Centre, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec H2J 1C5, Canada.
Kim L
KL
Lavoie
Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada; email: t.s.campbell@ucalgary.ca.
Joshua A
JA
Rash
Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada; email: t.s.campbell@ucalgary.ca.
Tavis S
TS
Campbell
D002908:Chronic Disease; D000066491:Clinical Decision-Making / Q000379:methods; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards*; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*
clinical inertia; clinical practice guidelines; diagnostic inertia; evidence-based medicine; therapeutic inertia