Analysis

Tackling therapeutic inertia: role of treatment data in quality indicators

BMJ 2007; 335 doi: 10.1136/bmj.39259.400069.AD (Published 13 September 2007)
Cite this as: BMJ 2007;335:542

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  1. Bruce Guthrie, professor1,
  2. Melanie Inkster, research fellow1,
  3. Tom Fahey, professor2
  1. 1Community Health Sciences, University of Dundee, Dundee DD2 4BF
  2. 2Department of Family Medicine and General Practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland
  1. Correspondence to: B Guthrie b.guthrie{at}chs.dundee.ac.uk
  • Accepted 8 June 2007

Many patients with hypertension remain undertreated despite the apparent rosy picture given by doctors meeting current targets. Different measures are needed to overcome therapeutic inertia, argue Bruce Guthrie, Melanie Inkster, and Tom Fahey

Inadequate management of risk factors for conditions such as hypertension, diabetes, and coronary heart disease remains an important international challenge.1 One approach is to set healthcare providers targets for blood pressure, glycated haemoglobin, or cholesterol levels in their populations. Such targets are commonly used as an indicator of quality of health care2 3 and are increasingly being incorporated into programmes that pay providers for performance. However, we show that fixed targets fail to identify clear opportunities for improving health care. We propose that future measures should include information on process of care information, which is more closely linked to better control of risk factors.2

Evidence from observational studies

Poor control of hypertension is defined as a failure to meet recommended blood pressure goals. Barriers to controlling hypertension include patient factors, such as non-adherence to lifestyle advice or drug treatment,4 and healthcare provider factors, including the organisation or environment where care is delivered.1 5 6 As measurement of quality of risk factor management has become routine, more attention has been paid to provider factors generally, and particularly therapeutic inertia—the failure to start new drugs or increase the dose in patients with an abnormal clinical measurement.7

Observational studies in the United States have found that therapeutic inertia is common in hypertension,1w1 w2 diabetes,w3 w4 and hypercholesterolaemia,w5 and is associated with poor control of risk factors known to be linked to longer term health problems.w5 w6 In our 2002 observational study of 560 hypertensive patients from eight general practices in Tayside, Scotland, adherence to blood pressure lowering treatment was high (mean 91%).8 …

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