December 11, 2007

BIRMINGHAM, Ala. – Physicians intensify medications for only about one of every five patients with uncontrolled risk factors, such as blood pressure, cholesterol and diabetes. Some propose that this phenomenon of inaction by physicians, known as clinical inertia, accounts for up to 80 percent of cardiovascular events. Yet, researchers at the University of Alabama at Birmingham (UAB) found that in some situations, failure to intensify medication is appropriate and may not reflect poor quality of care.

“The reasons for clinical inertia are poorly understood,” said Monika Safford, M.D., associate professor in the UAB Division of Preventive Medicine and the study’s lead author. “We asked primary care physicians why they do not intensify medications when blood pressure is high. Based on their answers, we developed a model of clinical inertia as a subset of all clinical inaction.”

Common reasons doctors offered for not intensifying medication were:

• Patient is not taking medications correctly.
  
• Patient’s hypertension has been difficult to control, and several medications have previously been tried.
  
• Patient can not afford medication.
  
• Patient is not adhering to concurrent factors such as smoking, weight control, diet, and alcohol consumption.
  
• Patient is experiencing side effects to medication.
  

“Our findings suggest that many apparent ‘failures’ of physicians to intensify medication regimens reflect potentially appropriate decisions,” Safford said. “Distinguishing potential clinical inertia from appropriate inaction is an important initial step for interventionists seeking to identify strategies to improve care and for policy makers seeking to measure health care quality.”

This study appears in the December edition of the Journal of General Internal Medicine.