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The accuracy of clinician perceptions of "usual" blood pressure control
Adam J Rose1, Stephanie L Shimada, James A Rothendler
1Center for Health Quality Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA 01730, USA. adamrose@bu.edu
Insights
Clinicians often wrongly assume hypertension is controlled, leading to clinical inertia. Objective data frequently showed elevated blood pressure (BP) when clinicians believed it was "usually well controlled," revealing a key factor in treatment gaps.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Clinical Practice
Background:
- Clinical inertia is the failure to intensify treatment for chronic conditions.
- The mechanisms driving clinical inertia are not well understood.
Purpose of the Study:
- To investigate a potential mechanism of clinical inertia.
- To examine clinician responses to computerized hypertension reminders.
Main Methods:
- A cohort study involving 509 hypertensive patients in Veterans Affairs primary care clinics.
- Clinicians' assertions that medication adjustments were unnecessary due to "usually well controlled" blood pressure (BP) were analyzed.
- Accuracy of these assertions was assessed using electronic medical record BP data.
Main Results:
- In 57% of cases, patients' recent BP readings were not well controlled.
- Elevated systolic BP was more common (56%) than elevated diastolic BP (13%).
- 18% of recent systolic BP readings were 160 mmHg or higher.
Conclusions:
- Clinician perceptions of
- usually well controlled
- blood pressure frequently contradicted objective measurements.
- This discrepancy offers insight into a significant mechanism contributing to clinical inertia in hypertension management.
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.
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