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Therapeutic inertia

There are two common methods used in calculating therapeutic inertia. For the following examples, consider that a patient has five visits with a health provider. In four of those visits, a condition is not controlled (such as high blood pressureorhigh cholesterol). In two of those visits, the provider made a change to the patient's treatment for the condition.

In Dr. Okonofua's original paper, this patient's therapeutic inertia is calculated as ${\displaystyle {\frac {h}{v}}-{\frac {c}{v}}}$ where h is the number of visits with an uncontrolled condition, c is the number of visits in which a change was made, and v is the total number of visits.^[2] Therefore, the patient's therapeutic inertia is ${\displaystyle {\frac {4}{5}}-{\frac {2}{5}}=0.4=40\%}$.

An alternative, which avoids consideration of visits where the condition was already controlled and the provider should not be expected to make a treatment change, is ${\displaystyle 1-{\frac {c}{h}}}$. Using the above example, there are 2 changes and 4 visits with an uncontrolled condition. The therapeutic inertia is ${\displaystyle 1-{\frac {2}{4}}=0.5=50\%}$.

Therapeutic inertia was devised as a metric for measuring treatment of hypertension. It has now become a standard metric for analysing treatment of many common comorbidities such as diabetes^[3] and hyperlipidemia.^[4] Both feedback reporting processes and intervention studies aimed at reducing therapeutic inertia have been shown to increase control of hypertension,^[5] diabetes, and hyperlipidemia.

• OQUIN: The OQUIN:Hypertension Initiative at MUSC performed the initial study and reporting on therapeutic inertia.