A narrative review of clinical inertia: focus on hypertension

Clinical practice guidelines report standards of care for the management of medical conditions based on review of evidence-based medicine. The inherent responsibility and challenge for health care providers is devising a patient-specific care plan through adaptations of established treatment recommendations using the latest clinical evidence and clinical decision-making skills. Clinical inertia (CI) is viewed as the failure of health care providers in adherence to or persistence with established treatment recommendations. The ability to implement an appropriate care plan is often limited not by available clinical evidence, but rather by humanistic influences. CI may result from being complacent with moderate to poor control resulting from a multitude of factors. The purpose of this review is to present existing evidence-based literature investigating CI, with an emphasis in hypertension. A literature search was performed using MEDLINE, Embase, and the Cochrane Database of Systematic Reviews. Review of the literature addressing CI finds that many authors offer solutions primarily directed at physician behavior, although it is also influenced by patient- and system-based factors. Programs that increase communication and influence behaviors based on clinical guidelines, such as academic detailing, medication-therapy management, and disease management programs, are warranted to combat CI.