Healthy Skepticism Library item: 11502

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Publication type: Journal Article

Guthrie B, Inkster M, Fahey T.
Tackling therapeutic inertia: role of treatment data in quality indicators
BMJ 2007 Sep 15; 335:(7619):542
http://www.bmj.com/cgi/content/short/335/7619/542?etoc

Abstract:

Many patients with hypertension remain undertreated despite the apparent rosy picture given by doctors meeting current targets. Different measures are needed to overcome therapeutic inertia, argue Bruce Guthrie, Melanie Inkster, and Tom Fahey

Inadequate management of risk factors for conditions such as hypertension, diabetes, and coronary heart disease remains an important international challenge.1 One approach is to set healthcare providers targets for blood pressure, glycated haemoglobin, or cholesterol levels in their populations. Such targets are commonly used as an indicator of quality of health care2 3 and are increasingly being incorporated into programmes that pay providers for performance. However, we show that fixed targets fail to identify clear opportunities for improving health care. We propose that future measures should include information on process of care information, which is more closely linked to better control of risk factors.2

Evidence from observational studies
Poor control of hypertension is defined as a failure to meet recommended blood pressure goals. Barriers to controlling hypertension include patient factors, such as non-adherence to lifestyle advice or drug treatment,4 and healthcare provider factors, including the organisation or environment where care is delivered.1 5 6 As measurement of . . .

Treatment intensification: definition and predictors

Evidence from randomised controlled trials

Use of process information to assess care

Summary points

b.guthrie@chs.dundee.ac.uk