The Accuracy of Clinician Perceptions of “Usual” Blood Pressure Control

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Abstract
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. To describe one potential mechanism for clinical inertia, seen through the lens of clinician responses to a computerized hypertension reminder. Cohort study. 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". Using recent BP values from the electronic medical record, we assessed the accuracy of this assertion. 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. 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.