2. Potential Reasons: Clinical Inertia in Chronic Diseases
Clinical inertia is one of the challenges associated with managing chronic medical conditions like diabetes [7]. It is defined as the failure or delay in treatment intensification among patients who do not achieve evidence-based or guideline-defined treatment goals. Clinical inertia can also be defined as the failure to achieve individually determined therapeutic objectives adapted to the respective living conditions and health status of the patient within a reasonable period of time.
Many factors underly clinical inertia,
including healthcare professional related factors, patient related factors, and process or system related factors [7].
- Errors in the therapeutic objectives
- Failure to initiate treatment
- Failure to intensify treatment until the therapeutic goal is achieved
- Lack of attention to comorbid disorders (e.g. depression)
- Jumping from one problem to another: frequent changes of issues due to poor doctor-patient communication
- Silent non-aggression pact: reactive instead of proactive treatment
- Insufficient time
- Lack of insight into/acceptance of the disease
- Lack of experience with the disease
- Low-level health literacy
- Cost of medication
- Too many medications
- Medication side effects
- Poor doctor-patient communication
- Lack of confidence in the doctor
- Mental problems, disorders (depression, substance abuse, etc.)
- Lack of routines for monitoring treatment outcomes
- Lack of planning for medical appointments
- No external support in clinical decisions
- No clinical guidelines
- Shortcomings in patient administration/databases
- No team approach to treatment
- Poor doctor-staff communication
[7] O'Connor et al. Clinical Inertia and Outpatient Medical Errors. In: Henriksen K et al., editors. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Rockville (MD), USA: Agency for Healthcare Research and Quality (US) 2005; pp. 293–308.
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