Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: A narrative review

Abstract

Objective: Clinical inertia, the absence of treatment initiation or intensification for patients not achieving evidence-based therapeutic goals, is a primary contributor to poor clinical outcomes. Effectively combating clinical inertia requires coordinated action on the part of multiple representatives including patients, clinicians, health systems, and the pharmaceutical industry. Despite intervention attempts by these representatives, barriers to overcoming clinical inertia in cardiovascular disease (CVD) risk factor control remain.

Methods: We conducted a narrative literature review to identify individual-level and multifactorial interventions that have been successful in addressing clinical inertia.

Results: Effective interventions included dynamic forms of patient and clinician education, monitoring of real-time patient data to facilitate shared decision-making, or a combination of these approaches. Based on findings, we describe three possible multi-level approaches to counter clinical inertia - a collaborative approach to clinician training, use of a population health manager, and use of electronic monitoring and reminder devices.

Conclusion: To reduce clinical inertia and achieve optimal CVD risk factor control, interventions should consider the role of multiple representatives, be feasible for implementation in healthcare systems, and be flexible for an individual patient's adherence needs.

Practice implications: Representatives (e.g., patients, clinicians, health systems, and the pharmaceutical industry) could consider approaches to identify and monitor non-adherence to address clinical inertia.

Keywords: Cardiovascular disease; Clinical inertia; Diabetes mellitus; Disease management; Medication adherence; Treatment outcome.

Figure 1.

PRISMA Diagram Note: The search was conducted in two phases. Phase 1 included articles from 01/2014 to 01/2019 and Phase 2 included articles from 01/2019 to 06/2021. Both searches followed the same methodological processes.

Figure 2.

Components of Three Proposed Multi-Level Interventions to Counter Clinical Inertia