The accuracy of clinician perceptions of "usual" blood pressure control

BACKGROUND: The term "clinical inertia" is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood. OBJECTIVE: To describe one potential mechanism for clinical inertia, seen through the lens of clinician responses to a computerized hypertension reminder. DESIGN: Cohort study. PARTICIPANTS: A total of 509 hypertensive patients from 2 primary care clinics in urban Veterans Health Administration (VA) Medical Centers. All patients had elevated blood pressure (BP) values that triggered a computerized reminder. Given a set of possible responses to the reminder, clinicians asserted at least once for each patient that medication adjustments were unnecessary because the BP was "usually well controlled". MEASUREMENTS: Using recent BP values from the electronic medical record, we assessed the accuracy of this assertion. RESULTS: In most instances (57%), recent BP values were not well controlled, with the systolic BP (56%) much more likely to be elevated than the diastolic BP (13%). Eighteen percent of recent systolic BP values were 160 mmHg or greater. CONCLUSIONS: When clinicians asserted that the BP was "usually well controlled", objective evidence frequently suggested otherwise. This observation provides insight into one potential mechanism underlying clinical inertia.