Nonadherence, clinical inertia, or therapeutic inertia?

in which certain therapies have adequate, even overwhelming if not unequivocal, evidence of effectiveness.5 Clinical inertia occurs, for example, when the patient fails to attain a biomarker goal (e.g., blood pressure less than 140/90 millimeters of mercury [mm Hg]) due at least in part to failure to intensify pharmacotherapy through upward dosing and/or addition of drugs to the therapeutic regimen. O’Connor et al. attributed clinical inertia 50% to physician factors, 30% to patient factors, and 20% to office-system factors.4 We might consider the latter category even more broadly to include all health-system factors (Table 1). While we are uncertain about the relative weights for these 3 categories of factors that contribute to clinical inertia, we propose that this conceptual model, including relative weights, should become a focal point in research in nonadherence and failure to attain biomarker and other clinical goals. While acknowledging access, cost, and patient nonadherence, Phillips et al. emphasized the role of clinicians when they wrote in 2001 that clinical inertia occurs when health care providers recognize the problem (failure to attain therapeutic targets in patients with hypertension, dyslipidemia, or diabetes) but fail to act (to initiate or intensify therapy). Clinical inertia is more than failure to act, and it has been shown that other factors such as clinician communication affect adherence. Zolnierek and DiMatteo (2009) discovered in a meta-analysis of 127 studies that the odds of adherence for patients whose physicians had been trained in communication skills were 1.62 times those of patients whose physicians did not receive communication training.6