Evidence map›Paper›PMID 17957346›Full record

ArticleJournal of general internal medicine2007

Reasons for not intensifying medications: differentiating "clinical inertia" from appropriate care.

Monika M Safford, Richard Shewchuk, Haiyan Qu, Jessica H Williams, Carlos A Estrada, Fernando Ovalle, Jeroan J Allison

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of general internal medicine, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00403091 (Internet Intervention to Improve Rural Diabetes Care), which is not on this map. Cited by 73 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
73citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00403091 nacompletednot on this map

Internet Intervention to Improve Rural Diabetes Care

TypeinterventionalSponsorUniversity of Alabama at BirminghamRan2005 to 2010Enrolled205ConditionsDiabetes Mellitus Type 2ArmsInternet Intervention, Control
3 · Its place in the literature

Who cites it

73 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Evaluating Therapeutic Inertia in Two Telehealth Interventions for Type 2 Diabetes: Secondary Analyses of a Randomized Trial.Telemedicine journal and e-health : the official journal of the American Telemedicine Association · 2024
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  8. A web-based diabetes intervention for physician: a cluster-randomized effectiveness trial.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2011
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13 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Monika M SaffordUniversity of Alabama at Birmingham, Birmingham, AL, USA. msafford@uab.edu
Richard Shewchuk
Haiyan Qu
Jessica H Williams
Carlos A Estrada
Fernando Ovalle
Jeroan J Allison

Funding

Internet Intervention For Improving Rural Diabetes CareR18DK065001 · NIDDK · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI ESTRADA, CARLOS A · 2005 to 2008
$2.1M
NIDDK NIH HHS R18 DK065001NIDDK NIH HHS R18DK65001-01A2
6 · The paper itself

Abstract

background"Clinical inertia" has been defined as inaction by physicians caring for patients with uncontrolled risk factors such as blood pressure. Some have proposed that it accounts for up to 80% of cardiovascular events, potentially an important quality problem. However, reasons for so-called clinical inertia are poorly understood.

objectiveTo derive an empiric conceptual model of clinical inertia as a subset of all clinical inactions from the physician perspective.

methodsWe used Nominal Group panels of practicing physicians to identify reasons why they do not intensify medications when seeing an established patient with uncontrolled blood pressure. MEASUREMENTS AND MAIN

resultsWe stopped at 2 groups (N = 6 and 7, respectively) because of the high degree of agreement on reasons for not intensifying, indicating saturation. A third group of clinicians (N = 9) independently sorted the reasons generated by the Nominal Groups. Using multidimensional scaling and hierarchical cluster analysis, we translated the sorting results into a cognitive map that represents an empirically derived model of clinical inaction from the physician's perspective. The model shows that much inaction may in fact be clinically appropriate care. CONCLUSIONS/RECOMMENDATIONS: Many reasons offered by physicians for not intensifying medications suggest that low rates of intensification do not necessarily reflect poor quality of care. The empirically derived model of clinical inaction can be used as a guide to construct performance measures for monitoring clinical inertia that better focus on true quality problems.

Indexed as

Practice Patterns, Physicians'AdultAntihypertensive AgentsBlood PressureDrug UtilizationFemaleGuideline AdherenceHumansHypertensionMaleMiddle AgedModels, TheoreticalMotivationPhysician-Patient RelationsPrimary Health CareRisk FactorsAntihypertensive Agents

Identifiers

PMID17957346
PMCPMC2219839

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.