Therapeutic inertia in the management of hypertension by moroccan general practitioners

Abstract

Abstract Background Hypertension is an important and remediable risk factor for cardiovascular disease. Therapeutic inertia has been identified as one of the main factors associated with poor blood pressure control. Purpose This study aims to evaluate predictive factors of therapeutic inertia in the management of hypertension among moroccan general practitioners. Methods We conducted a descriptive and analytical cross-sectional study, from October 2021 to January 2022, involving moroccan general practitioners using a standardized, anonymous questionnaire, covering numerous areas; their socio-demographic characteristics, assessment of hypertension knowledge, reasons not to intensify therapy and clinical scenarios. A univariate analysis was performed using the Chi-square test for the comparison of percentages. A multivariable logistic regression analysis was also applied to study variables possibly associated with therapeutic inertia. Results A total of 130 physicians participated in our study. The majority of the practitioners were female (62.3%). The average age was 38.61 years (±13,95). The percentage of physicians who had practiced for 5 years or less was 51.5% vs. 48,5% having practiced for more than 5 years. The median number of patients seen per day was estimated at 30 patients with an interquartile range of [15, 50]. The average medical visit time was estimated at 11,88 ± 7,03 minutes. The overall frequency of therapeutic inertia among general practitioners was estimated at 78,5% CI 95% [70,4-85,2]. Furthermore, the two main reasons for therapeutic abstention reported by physicians were: the importance of improving patient compliance, lifestyle and dietary measures before intensifying treatment (81,5%), in addition to the fact that the office blood pressure does not reflect the patient's "true" BP and didn’t need any further ambulatory monitoring (43,8%). Multivariable regression showed that when the patient is diabetic, the general practitioners tend to be 4 times more ‘therapeutically inert’ [OR 4.42 (95% CI 1.2–7.23)]. A patient’s history of ischemic stroke was also positively associated with TI [OR 1.53 (95% CI 1.23–4.23)]. Conclusion This study revealed a significant frequency of therapeutic inertia in primary care. A good understanding of the determinants of this phenomenon will lead to better management of hypertension and therefore better blood pressure control. According to our study, a history of diabetes or stroke was positively associated with inertia, even though this would normally require exhaustive BP control. Thus, the development of operational and consensual definitions based on empirical data and the exploration of the intimate mechanisms underlying this inertia is of crucial importance.Table 1