Clinical inertia in general practice, a matter of debate: A qualitative study with 114 general practitioners in Belgium

Abstract

Background: Prescribing that is not concordant with guidelines is increasingly referred to as clinical inertia (CI). However, CI may be only apparent, and the absence of decision may actually reflect appropriate inaction as a result of good clinical reasoning. Our study aimed to: (i) elucidate GPs' beliefs regarding CI and the risk of CI in their own practice, (ii) identify modifiable provider-related factors associated with CI. Methods: We conducted 8 group interviews with 114 general practitioners (GP) in Belgium, and used an integrated approach of thematic analysis. Results: Our results call for a redefinition of CI, in order to take into account the GPs' extended health-promoting role, and acknowledge that inaction or delayed action follows a process of clinical reasoning that takes into account the patients' preferences, and that is appropriate most of the time. However, the participants in our study did acknowledge that the risk of CI exists in practice. The main factor of such a risk is when GPs feel overwhelmed and disempowered, due to characteristics of either the patients or the health care system, including contradictions between guidelines and reimbursement policies. Conclusions: Although situations of clinical inertia exist in practice and need to be prevented or corrected, the term clinical inertia could potentially increase the already existing gap between general practice and specialised care, whereas sustained efforts toward more collaborative work and integrated care are called for.