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The accuracy of clinician perceptions of "usual" blood pressure control.

Abstract：

BACKGROUND:The term "clinical inertia" is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood. OBJECTIVE:To describe one potential mechanism for clinical inertia, seen through the lens of clinician responses to a computerized hypertension reminder. DESIGN:Cohort study. PARTICIPANTS:A total of 509 hypertensive patients from 2 primary care clinics in urban Veterans Health Administration (VA) Medical Centers. All patients had elevated blood pressure (BP) values that triggered a computerized reminder. Given a set of possible responses to the reminder, clinicians asserted at least once for each patient that medication adjustments were unnecessary because the BP was "usually well controlled". MEASUREMENTS:Using recent BP values from the electronic medical record, we assessed the accuracy of this assertion. RESULTS:In most instances (57%), recent BP values were not well controlled, with the systolic BP (56%) much more likely to be elevated than the diastolic BP (13%). Eighteen percent of recent systolic BP values were 160 mmHg or greater. CONCLUSIONS:When clinicians asserted that the BP was "usually well controlled", objective evidence frequently suggested otherwise. This observation provides insight into one potential mechanism underlying clinical inertia.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Rose AJ,Shimada SL,Rothendler JA,Reisman JI,Glassman PA,Berlowitz DR,Kressin NR

doi

10.1007/s11606-007-0464-1

subject

Has Abstract

pub_date

2008-02-01 00:00:00

pages

180-3

issue

2

eissn

0884-8734

issn

1525-1497

journal_volume

23

pub_type

杂志文章,多中心研究

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