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. 2018 Jul 30;8(7):e020599.
doi: 10.1136/bmjopen-2017-020599.

Consensus study to define appropriate inaction and inappropriate inertia in the management of patients with hypertension in primary care

Jean-Pierre Lebeau  1 , Julie Biogeau  1 , Maxime Carré  1 , Alain Mercier  2 , Isabelle Aubin-Auger  3 , Emmanuel Rusch  4 , Roy Remmen  5 , Etienne Vermeire  5 , Kristin Hendrickx  5
Affiliations

Consensus study to define appropriate inaction and inappropriate inertia in the management of patients with hypertension in primary care

Jean-Pierre Lebeau et al. BMJ Open. .

Abstract

Objectives: To elaborate and validate operational definitions for appropriate inaction and for inappropriate inertia in the management of patients with hypertension in primary care.

Design: A two-step approach was used to reach a definition consensus. First, nominal groups provided practice-based information on the two concepts. Second, a Delphi procedure was used to modify and validate the two definitions created from the nominal groups results.

Participants: 14 French practicing general practitioners participated in each of the two nominal groups, held in two different areas in France. For the Delphi procedure, 30 academics, international experts in the field, were contacted; 20 agreed to participate and 19 completed the procedure.

Results: Inappropriate inertia was defined as: to not initiate or intensify an antihypertensive treatment for a patient who is not at the blood pressure goals defined for this patient in the guidelines when all following conditions are fulfilled: (1) elevated blood pressure has been confirmed by self-measurement or ambulatory blood pressure monitoring, (2) there is no legitimate doubt on the reliability of the measurements, (3) there is no observance issue regarding pharmacological treatment, (4) there is no specific iatrogenic risk (which alters the risk-benefit balance of treatment for this patient), in particular orthostatic hypotension in the elderly, (5) there is no other medical priority more important and more urgent, and (6) access to treatment is not difficult. Appropriate inaction was defined as the exact mirror, that is, when at least one of the above conditions is not met.

Conclusion: Definitions of appropriate inaction and inappropriate inertia in the management of patients with hypertension have been established from empirical practice-based data and validated by an international panel of academics as useful for practice and research.

Keywords: hypertension; primary care; quality in health care; therapeutics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart. NG, nominal group.
See this image and copyright information in PMC

References

    1. World health organization. A global brief on hypertension. Silent killer, global public health crisis. Geneva: WHO, 2013.
    1. Yoon SS, Gu Q, Nwankwo T, et al. . Trends in blood pressure among adults with hypertension: United States, 2003 to 2012. Hypertension 2015;65:54–61. 10.1161/HYPERTENSIONAHA.114.04012 - DOI - PMC - PubMed
    1. Sipilä R, Helin-Salmivaara A, Korhonen MJ, et al. . Change in antihypertensive drug prescribing after guideline implementation: a controlled before and after study. BMC Fam Pract 2011;12:87 10.1186/1471-2296-12-87 - DOI - PMC - PubMed
    1. Jeffery RA, To MJ, Hayduk-Costa G, et al. . Interventions to improve adherence to cardiovascular disease guidelines: a systematic review. BMC Fam Pract 2015;16:147 10.1186/s12875-015-0341-7 - DOI - PMC - PubMed
    1. Herttua K, Tabák AG, Martikainen P, et al. . Adherence to antihypertensive therapy prior to the first presentation of stroke in hypertensive adults: population-based study. Eur Heart J 2013;34:2933–9. 10.1093/eurheartj/eht219 - DOI - PMC - PubMed

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