Abstract
BackgroundPrescribing that is not concordant with guidelines is increasingly referred to as clinical inertia (CI). However, CI may be only apparent, and the absence of decision may actually reflect appropriate inaction as a result of good clinical reasoning. Our study aimed to: (i) elucidate GPs’ beliefs regarding CI and the risk of CI in their own practice, (ii) identify modifiable provider-related factors associated with CI.MethodsWe conducted 8 group interviews with 114 general practitioners (GP) in Belgium, and used an integrated approach of thematic analysis.ResultsOur results call for a redefinition of CI, in order to take into account the GPs’ extended health-promoting role, and acknowledge that inaction or delayed action follows a process of clinical reasoning that takes into account the patients’ preferences, and that is appropriate most of the time. However, the participants in our study did acknowledge that the risk of CI exists in practice. The main factor of such a risk is when GPs feel overwhelmed and disempowered, due to characteristics of either the patients or the health care system, including contradictions between guidelines and reimbursement policies.ConclusionsAlthough situations of clinical inertia exist in practice and need to be prevented or corrected, the term clinical inertia could potentially increase the already existing gap between general practice and specialised care, whereas sustained efforts toward more collaborative work and integrated care are called for.
Highlights
Prescribing that is not concordant with guidelines is increasingly referred to as clinical inertia (CI)
general practitioners (GP)’ beliefs regarding CI and the risk of CI in their own practice To initiate a discussion about CI in general practice raised mixed feelings
Called for a redefinition of CI, in order to take into account their health-promoting role and to acknowledge that most decisions are taken as a result of a complex process of clinical reasoning, and should not be mistaken for CI
Summary
Prescribing that is not concordant with guidelines is increasingly referred to as clinical inertia (CI). It has been suggested that CI related to management of diabetes, hypertension and lipid disorders may contribute up to 80% of heart attacks and strokes [4]. As it associates with poor control of risk factors known to. The three provider-related factors that were initially defined by Phillips et al [1] are assumed to be the most common contributors to CI [2,4,9]: (i) providers’ overestimation of the care they give; (ii) providers’ use of ‘soft’ reasons to avoid therapy; (iii) providers’ lack of education, training or organisation for achieving therapeutic goals
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