The problem of «medical inertia» in the practice of an ophthalmologist

The authors study the problem of inertia in the medical practice of ophthalmology, which implies the absence of any modification of the treatment in the presence of objective necessity or clinical indications. The treatment of multifactorial diseases, including primary glaucoma is particularly critical. An anonymous survey of 147 ophthalmologists from different regions of Western Siberia — Altai Territory, Kemerovo Region and the Republic of Khakassia, has been conducted. Most of the surveyed doctors believed that their treatment was successful in 40‑80 % of patients. According to literature data, ithe target value of IOP level is achieved in practice in under half of the patients receiving regular therapy. Another reason of medical inertia was the fear of polypragmasy. Almost 54 % of doctors said they are afraid to prescribe several medications, which limits their desire to intensify therapy. The results of our study suggest that the cost of glaucoma treatment, i.e. the fear to prescribe an expensive treatment for patients does not significantly determine the doctors’activity. Doctors often exaggerate the fear of patients for the treatment, believing that a particular medical drug
will not be taken by the patient, without trying to figure out the patient’s intention. The economic barrier has become an essential factor for our doctors, as 35 % ophthalmologists believe that 300‑500 Rubles for the therapy per month is expencive for a patient. Over 30 % respondents discussed with the patient the prescribed treatment with cost about 700‑900 Rubles. This could potentially lead to the fact, that the second and third medical drugs would be less likely prescribed due to the increased cost of treatment. Thus, we have set up the structure of the causes of medical inertia — a psychological unwillingness to achieve target values of IOP, overestimation of the therapy success. Less important reasons were the lack of doctor’s awareness and the economic barrier forthe decision making.

1. Erichev V. P., Tumanov V. P., Panyushkina L. A. [Glaucoma and neurodegenerative disease] [Glaucomе]. Glaukoma. 2012; 1: 45‑49 (in Russ.).

2. Nesterov A. P. [Glaucoma: the main challenges and new opportunities] [Annals of ophthalmology] Vestnik oftal’mologii. 2008; 1: 3‑5. (in Russ.).

3. [National guidelines for glaucoma for medical practitioners, еd. by E. A. Egorova, Yu. S. Astakhova, A. G. Shchuko.] Natsional’noe rukovodstvo po glaukome: dlya praktikuyushchikh vrachey. Мoscow, GEOTAR Media; 2011. (in Russ.).

4. O’Connor PJ, Sperl-Hillen JM, Johnson PE, Rush WA, Blitz G. Clinical inertia and outpatient medical errors. Advances in Patient Safety. 2005;2:293‑308.

5. 5.. Onishchenko A. L., Likhacheva I. G., Plastinina S. L., Tkachev V. A. [Reasons of poor compliance in glaucoma patients and its correction modalities] [Glaucomе]. Glaukoma. 2009; 4: 39‑43. (in Russ.).

6. Egan BM, Basile JN. Controlling blood pressure in 50 % of all hypertensive patients: an achievable goal in the Healthy People 2010 Report? J Investig Med.2003;51:373‑85.

7. Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Intern Med. 2001; 135: 825‑34.

8. Okonofua KN, Simpson K, Jesri A et al. Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control Goals. Hypertension 2006;47:345‑51.

9. Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician related barriers to the effective management of uncontrolled hypetension. Arch Intern Med. 2002; 162:.413‑20.

10. Roumie CL, Elasy TA, Wallston KA. Clinical inertia: a common barrier to changing provider prescribing behavior. Jt Comm J Qual Patient Saf. 2007;33 (5):277‑85.

11. Margolis KL, Rolnick SJ, Fortman KK et al. Self-reported hypertension treatment beliefs and practices of primary care physicians in a managed care organization. Am J Hypertens. 2005;18 (4): 566‑71.

12. Fahey T, Schroeder K, Ebrahim S. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2005;1.-CD 005182.

13. Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998; 339:1957‑63.