Table 1 Causes of clinical inertia
Clinician-related | Patient-related | Healthcare system/practice-related |
|---|---|---|
Insufficient time | Denial of having the disease | No clinical guidelines |
Work overload | Denial that the disease is serious | No disease register |
Burn-out | Absence of symptoms | Bureaucratic difficulties with new drugs |
Inadequate knowledge of Guidelines and up-to-date scientific evidence | Low health literacy | Inadequate technologies support |
Lack of familiarity with the new therapies | Too many medications | Resource constraints |
Failure to set clear goals | Therapeutic regimen too complex | Resistance to change in the system |
Difficulty in managing more complex injection therapies | Medication side effects | No visit planning |
Failure to initiate treatment | Depression or substances abuse | No active outreach to patients |
Failure to titrate treatment to achieve goals | Lifestyle factors | No decision support |
Fear of side effects | Cognitive, emotional and behavioral obstacles | No team approach to care |
Difficulty in managing side effects | Poor communication between physician and patient | Poor communication between physicians and staff |
Failure to identify and manage comorbidities (e.g. depression) | Psychological resistance to insulin | Not structured education activity |
Reactive than proactive care | ||
Underestimation of patient’s need | ||
Inadequate physician–patient communication | ||
Presence of cognitive bias with lack of rationality in decision making |