Therapeutic inertia

Therapeutic inertia (also known as clinical inertia^[1]) is a measurement of the resistance to therapeutic treatment for an existing medical condition. It is commonly measured as a percentage of the number of encounters in which a patient with a condition received new or increased therapeutic treatment out of the total number of visits to a health care professional by the patient. A high percentage indicates that the health care provider is slow to treat a medical condition. A low percentage indicates that a provider is extremely quick in prescribing new treatment at the onset of any medical condition.

Calculation[edit]

There are two common methods used in calculating therapeutic inertia. For the following examples, consider that a patient has five visits with a health provider. In four of those visits, a condition is not controlled (such as high blood pressure or high cholesterol). In two of those visits, the provider made a change to the patient's treatment for the condition.

In Dr. Okonofua's original paper, this patient's therapeutic inertia is calculated as ${\frac {h}{v}}-{\frac {c}{v}}$ where h is the number of visits with an uncontrolled condition, c is the number of visits in which a change was made, and v is the total number of visits.^[2] Therefore, the patient's therapeutic inertia is ${\frac {4}{5}}-{\frac {2}{5}}=0.4=40\%$ .

An alternative, which avoids consideration of visits where the condition was already controlled and the provider should not be expected to make a treatment change, is $1-{\frac {c}{h}}$ . Using the above example, there are 2 changes and 4 visits with an uncontrolled condition. The therapeutic inertia is $1-{\frac {2}{4}}=0.5=50\%$ .

Reception[edit]

Therapeutic inertia was devised as a metric for measuring treatment of hypertension. It has now become a standard metric for analysing treatment of many common comorbidities such as diabetes^[3] and hyperlipidemia.^[4] Both feedback reporting processes and intervention studies aimed at reducing therapeutic inertia have been shown to increase control of hypertension,^[5] diabetes, and hyperlipidemia.

References[edit]

^ Reach, Gérard (2014-09-12), "To Do or Not to Do: A Critique of Medical Reason medical reason", Clinical Inertia, Cham: Springer International Publishing, pp. 73–95, doi:10.1007/978-3-319-09882-1_6, ISBN 978-3-319-09881-4, retrieved 2020-12-19
^ Eni C. Okonofua; Kit N. Simpson; Ammar Jesri; Shakaib U. Rehman; Valerie L. Durkalski; Brent M. Egan (January 23, 2006). "Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control Goals". Hypertension. 47 (2006, 47:345): 345–51. doi:10.1161/01.HYP.0000200702.76436.4b. PMID 16432045.
^ Diabetes care: therapeutic inertia in doctors and patients
^ Getting Patients to Their Lipid Targets: A Practical Approach to Implementing Therapeutic Lifestyle Changes
^ Is blood pressure control to less than 140/less than 90 mmHg in 50% of all hypertensive patients as good as we can do in the USA: or is this as good as it gets?

External links[edit]

OQUIN: The OQUIN:Hypertension Initiative at MUSC performed the initial study and reporting on therapeutic inertia.

[1] Reach, Gérard (2014-09-12), "To Do or Not to Do: A Critique of Medical Reason medical reason", Clinical Inertia, Cham: Springer International Publishing, pp. 73–95, doi:10.1007/978-3-319-09882-1_6, ISBN 978-3-319-09881-4, retrieved 2020-12-19

[okonofua-2] Eni C. Okonofua; Kit N. Simpson; Ammar Jesri; Shakaib U. Rehman; Valerie L. Durkalski; Brent M. Egan (January 23, 2006). "Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control Goals". Hypertension. 47 (2006, 47:345): 345–51. doi:10.1161/01.HYP.0000200702.76436.4b. PMID 16432045.

[3] Diabetes care: therapeutic inertia in doctors and patients

[4] Getting Patients to Their Lipid Targets: A Practical Approach to Implementing Therapeutic Lifestyle Changes

[5] Is blood pressure control to less than 140/less than 90 mmHg in 50% of all hypertensive patients as good as we can do in the USA: or is this as good as it gets?

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