Clinical Inertia in Poorly Controlled Elderly Hypertensive Patients: A Cross-Sectional Study in Spanish Physicians to Ascertain Reasons for Not Intensifying Treatment
| Autor: | Diego González-Segura, Antonio Fernandez, Domingo Orozco-Beltrán, Vicente Francisco Gil-Guillén, Salvador Pertusa-Martínez, Salvador Pita-Fernández, Ramon Durazo-Arvizu, Vicente Pallarés, José Luis Martin-de-Pablo, Richard S. Cooper, Josep Redon, Concepción Carratalá-Munuera, Emilio Márquez-Contreras |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Medicina Cross-sectional study Treatment outcome Alternative medicine MEDLINE Pharmacotherapy Physicians medicine Humans Cor Pharmacology (medical) Hypertension diagnosis Intensive care medicine Antihypertensive Agents Aged Physician-Patient Relations business.industry General Medicine Middle Aged Cross-Sectional Studies Treatment Outcome Multicenter study Spain Hypertension Female Clinical Competence Clinical competence Cardiology and Cardiovascular Medicine business |
| Zdroj: | Gil Guillén, Vicente F.; Orozco Beltrán, Domingo; Carratalá Munuera, Concepción; Márquez Contreras, Emilio; Durazo Arvizu, Ramón; Cooper, Richard; Pertusa Martínez, Salvador; Pita Fernandez, Salvador; González Segura, Diego; Martin de Pablo, José Luis; Pallarés, Vicente; Fernández, Antonio; Redón Mas, Josep (2013) Clinical inertia in poorly controlled elderly hypertensive patients: a cross-sectional study in Spanish physicians to ascertain reasons for not intensifying treatment American Journal Of Cardiovascular Drugs 13 3 213 219 RODERIC. Repositorio Institucional de la Universitat de Valéncia instname |
| ISSN: | 1179-187X 1175-3277 |
| DOI: | 10.1007/s40256-013-0025-4 |
| Popis: | 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.The objective of our study was to determine the rate of clinical inertia and the physician-reported reasons for it.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.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.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.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. |
| Databáze: | OpenAIRE |
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