Clinical inertia
Clinical inertia
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DOI：
10.7326/0003-4819-135-9-200111060-00012
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发表时间：
2001-11-06
影响因子：
39.2
通讯作者：
Barnes, CS
中科院分区：
文献类型：
--
作者：
Phillips, LS;Branch, WT Jr;Barnes, CS
传统上，医学的重点是缓解患者的症状。然而，在发达国家，保持良好的健康越来越多地涉及到高血压、血脂异常和糖尿病等问题的管理，这些问题往往没有症状。此外，血压、血脂和血糖值的异常通常足以保证治疗，而无需进一步的诊断操作。管理此类问题的局限性往往是由于临床惰性--卫生保健提供者未能在需要时启动或加强治疗。临床惰性至少有三个问题：高估所提供的治疗；使用“软”理由来避免强化治疗；以及缺乏旨在实现治疗目标的教育、培训和实践组织。克服临床惰性的策略必须以医学生、住院医生和执业医生为重点。修订后的教育计划应该导致三个概念的同化：针对治疗目标进行治疗的好处，针对不同疾病进行目标治疗的实际复杂性，以及需要构建常规做法，以促进对患者症状的解决不足以指导护理的疾病的有效管理。医生将需要在他们的执业中建立一个提醒和业绩反馈系统，以确保必要的护理。
Medicine has traditionally focused on relieving patient symptoms. However, in developed countries, maintaining good health increasingly involves management of such problems as hypertension, dyslipidemia, and diabetes, which often have no symptoms. Moreover, abnormal blood pressure, lipid, and glucose values are generally sufficient to warrant treatment without further diagnostic maneuvers. Limitations in managing such problems are often due to clinical inertia-failure of health care providers to initiate or intensify therapy when indicated. Clinical inertia is due to at least three problems: overestimation of care provided; use of "soft" reasons to avoid intensification of therapy; and lack of education, training, and practice organization aimed at achieving therapeutic goals. Strategies to overcome clinical inertia must focus on medical students, residents, and practicing physicians. Revised education programs should lead to assimilation of three concepts: the benefits of treating to therapeutic targets, the practical complexity of treating to target for different disorders, and the need to structure routine practice to facilitate effective management of disorders for which resolution of patient symptoms is not sufficient to guide care. Physicians will need to build into their practice a system of reminders and performance feedback to ensure necessary care.