Review: Clinical Inertia in the Management of Chronic Obstructive Pulmonary Disease

Figures & data

Figure 1  Management of patients with COPD by Stage (2). *Reproduced with permission from the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011. Available from: http://www.goldcopd.org.

Table 1.  Possible factors that contribute to clinical inertia in COPD*

Provider	Patient	Health System
1) Nihilistic attitude towards disease: belief that COPD is Self-inflicted (27, 28)	1) Medication non-adherence (32, 34)	1) No implementation of guidelines (37, 38)
2) Misconceptions about disease (29)	2) Lack of education about disease (10, 35)	2) Limited access to treatment (Insurance) (4, 28)
3) Unaware of guidelines (28–30)	3) Severity of disease (28)	3) No active patient outreach
4) Training: discomfort with diagnosis or treatment/ generalist vs. specialist (30)	4) Denial of disease severity (36)	4) No decision support
5) Misdiagnosis/underdiagnosis (Lack of spirometry use) (4, 10, 12–20, 31)	5) Lifestyle choices (Continued smoking)	5) No disease registry
6) Lack of non-pharmacologic Treatment (4, 19, 26)	6) Lack of Inhaler technique education	6) Poor communication between health care providers and staff
7) Under-treatment (5, 10, 19, 27, 28, 32)	7) Clinician mistrust	7) No team approach (no involvement of non-physician providers)
8) Overtreatment/inappropriate therapy	8) Poor self-care	8) Lack of coordination of care
9) Insufficient time (4, 16)	9) Mental illness	9) Lack of quality measures to improve care
10) Failure to address co-morbid conditions
11) Reactive rather than proactive
12) Lack of communicating/educating patients about COPD (4, 33)

*Adapted from Allen et al. 2009 (7) and updated with a COPD focus.

Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (Updated 2010). Available at: http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf. Accessed September 30, 2011.

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