Factors associated with clinical inertia: an integrative review

Abstract

Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice. This integrative review seeks to address the factors generally associated with clinical inaction, in order to better delineate the concept of true clinical inertia.

Keywords:

• clinical inertia
• evidence-based medicine
• clinical decision
• integrative review
• concept clarification
• physician adherence to guidelines

Acknowledgments

We would like to acknowledge the contributions of Hans Vandenberghe and Annelies Vankeirsbilck, respectively Lead Medical Affairs and Medical Affairs Manager, at AstraZeneca Belgium & Luxembourg, who participated in the design of the study, set up a scientific steering committee (coauthors), and facilitated discussions between the members of the steering committee around the concept of clinical inertia. We would like to thank them not only for the financial support received, but also for the very positive and open discussions and feedback from study design to preparation of the manuscript. The authors are also grateful to Cécile Fournier for her perceptive insights during informal discussions with the first author (IA) around the concept of clinical inertia and to Eric Legrand for invaluable administrative support.

Disclosure

The study received financial support from AstraZeneca Belgium and Luxembourg.