Journal
JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY
Volume 33, Issue 5, Pages 277-285Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/S1553-7250(07)33032-8
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Funding
- Veterans Affairs Clinical Research Center of Excellence
- Geriatric Research Education Clinical Center (GRECC)
- HSR&D Center for Patient Healthcare Behavior
- VA Career Development Award [04-342-2]
- Health Services Research-VISN Cooperative Grant [IMV 04-091-1]
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Background: A cross-sectional content analysis nested within a randomized, controlled trial was conducted to collect information on provider responses to computer alerts regarding guideline recommendations for patients with suboptimal hypertension care. Methods: Participants were providers who cared for 1,017 patients with uncontrolled hypertension on a single antihypertensive agent within Veterans Affairs primary care clinics. All reasons for action or inaction were sorted into a framework to explain the variation in guideline adaptation. Results: The 184 negative provider responses to computer alerts contained explanations for not changing patient treatment; 76 responses to the alerts were positive, that is, the provider was going to make a change in antihypertensive regimen. The negative responses were categorized as: inertia of practice (66%), lack of agreement with specific guidelines (5%), patient-based factors (17%), environmental factors (10%), and lack of knowledge (2%). Most of the 135 providers classified as inertia of practice indicated, Continue current medications and I will discuss at the next visit. The median number of days until the next visit was 45 days (interquartile range, 29 to 78 days). Discussion: Clinical inertia was the primary reason for failing to engage in otherwise indicated treatment change in a subgroup of patients. A framework was provided as a taxonomy for classification of provider barriers.
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