Analysing the concept of diagnostic inertia in hypertension: a cross-sectional study
Por:
Pallares-Carratalá V, Bonig-Trigueros I, Palazon A, Lorenzo-Piqueres A, Valls-Roca F, Orozco D and Gil V
Publicada:
1 jul 2016
Categoría:
Medicine (miscellaneous)
Resumen:
AimsThe aim of this study was to quantify diagnostic inertia (DI) when the physician fails to diagnose hypertension and determine its associated factors.
MethodsThis cross-sectional, observational study involved all patients without a diagnosis of hypertension who had their blood pressure (BP) measured at least three times during the second half of 2010 (N=48,605). Patients with altered mean BP figures (140/90mmHg) were considered to experience DI. Secondary variables: gender, atrial fibrillation, diabetes mellitus, dyslipidemia, cardiovascular disease, age and the physician having attended a cardiovascular training course (ESCARVAL). Associated factors were assessed by multivariate logistic regression analysis.
ResultsDiagnostic inertia was present in 6450 patients (13.3%, 95% CI: 13.0-13.6%). Factors significantly associated with DI were: male gender (OR=1.46, 95% CI: 1.37-1.55, p<0.001), atrial fibrillation (OR=0.73, 95% CI: 0.58-0.92, p=0.007), the ESCARVAL cardiovascular course (OR=0.88, 95% CI: 0.81-0.96, p=0.005), diabetes mellitus (OR=0.93, 95% CI: 0.87-0.99, p=0.016), cardiovascular disease (OR=0.77, 95% CI: 0.67-0.88, p<0.001) and older age (years) (18-44OR=1; 45-59OR=12.45, 95% CI: 11.11-13.94; 60-74OR=18.11, 95% CI: 16.30-20.12; 75OR=20.43, 95% CI: 18.34-22.75; p<0.001). The multivariate model had an area under the ROC curve of 0.81 (95% CI: 0.80-0.81, p<0.001).
ConclusionsThis study will help clinical researchers differentiate between the two forms of DI (interpretation of a positive screening test and interpretation of positive diagnostic criteria). The results found here in patients with hypertension suggest that this problem is prevalent, and that a set of associated factors can explain the outcome well (AUC>0.80).
Filiaciones:
:
Health Surveillance Department, Mutual Society of Castellón, Castellón, Spain
Department of Medicine, Jaume I University, Castellón, Spain
:
Internal Medicine Service, La Plana Hospital, Vila-real, Spain
Palazon A:
Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
Research Unit, Elda General Hospital, Elda, Spain
:
Teaching Unit of Primary Health Care, Generalitat Valenciana, Castellón, Spain
:
Health Centre of Benigánim, Generalitat Valenciana, Benigánim, Spain
Orozco D:
Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
Gil V:
Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain
Research Unit, Elda General Hospital, Elda, Spain
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