Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.


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Literature Cited

  1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. 1.  1996. Evidence based medicine: what it is and what it isn't. BMJ 312:71–72 [Google Scholar]
  2. Rosenberg W, Donald A. 2.  1995. Evidence based medicine: an approach to clinical problem-solving. BMJ 310:1122–26 [Google Scholar]
  3. Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E. 3.  2011. Clinical Practice Guidelines We Can Trust Washington, DC: Natl. Acad. Press [Google Scholar]
  4. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH. 4.  et al. 1999. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 282:1458–65 [Google Scholar]
  5. Carlhed R, Bojestig M, Wallentin L, Lindstrom G, Peterson A. 5.  et al. 2006. Improved adherence to Swedish national guidelines for acute myocardial infarction: the Quality Improvement in Coronary Care (QUICC) study. Am. Heart J. 152:1175–81 [Google Scholar]
  6. Grimshaw JM, Russell IT. 6.  1993. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342:1317–22 [Google Scholar]
  7. Lugtenberg M, Burgers JS, Westert GP. 7.  2009. Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Qual. Saf. Health Care 18:385–92 [Google Scholar]
  8. Sager HB, Linsel-Nitschke P, Mayer B, Lieb W, Franzel B. 8.  et al. 2010. Physicians' perception of guideline-recommended low-density lipoprotein target values: characteristics of misclassified patients. Eur. Heart J. 31:1266–73 [Google Scholar]
  9. Balder JW, Scholtens S, de Vries JK, van Schie LM, Boekholdt SM. 9.  et al. 2015. Adherence to guidelines to prevent cardiovascular diseases: the LifeLines cohort study. Neth. J. Med. 73:316–23 [Google Scholar]
  10. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J. 10.  et al. 2003. The quality of health care delivered to adults in the United States. N. Engl. J. Med. 348:2635–45 [Google Scholar]
  11. O'Connor PJ, Sperl-Hillen JM, Johnson PE, Rush WA, Biltz G. 11.  2005. Clinical inertia and outpatient medical errors. Advances in Patient Safety: From Research to Implementation 2 Concepts and Methodology K Henriksen, JB Battles, ES Marks, DI Lewin 293–308 Rockville, MD: Agency Healthc. Res. Qual. [Google Scholar]
  12. Grahame-Smith D. 12.  1995. Evidence based medicine: Socratic dissent. BMJ 310:1126–27 [Google Scholar]
  13. Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM. 13.  et al. 2001. Clinical inertia. Ann. Intern. Med. 135:825–34 [Google Scholar]
  14. Allen JD, Curtiss FR, Fairman KA. 14.  2009. Nonadherence, clinical inertia, or therapeutic inertia?. J. Manag. Care Pharm. 15:690–95 [Google Scholar]
  15. Faria C, Wenzel M, Lee KW, Coderre K, Nichols J, Belletti DA. 15.  2009. A narrative review of clinical inertia: focus on hypertension. J. Am. Soc. Hypertens. 3:267–76 [Google Scholar]
  16. Okonofua EC, Simpson KN, Jesri A, Rehman SU, Durkalski VL, Egan BM. 16.  2006. Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension 47:345–51 [Google Scholar]
  17. Garfinkel D, Mangin D. 17.  2010. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch. Intern. Med. 170:1648–54 [Google Scholar]
  18. Hicks PC, Westfall JM, Van Vorst RF, Bublitz Emsermann C, Dickinson LM. 18.  et al. 2006. Action or inaction? Decision making in patients with diabetes and elevated blood pressure in primary care. Diabetes Care 29:2580–85 [Google Scholar]
  19. Reach G. 19.  2014. Clinical Inertia: A Critique of Medical Reason New York: Springer [Google Scholar]
  20. Asche C, Bode B, Busk A, Nair S. 20.  2012. The economic and clinical benefits of adequate insulin initiation and intensification in people with type 2 diabetes mellitus. Diabetes Obes. Metab. 14:47–57 [Google Scholar]
  21. 21. UK Prospect. Diabetes Study Group 1998. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–53 [Google Scholar]
  22. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S. 22.  et al. 1995. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res. Clin. Pract. 28:103–17 [Google Scholar]
  23. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW. 23.  2008. 10-year follow-up of intensive glucose control in type 2 diabetes. N. Engl. J. Med. 359:1577–89 [Google Scholar]
  24. Khunti K, Wolden ML, Thorsted BL, Andersen M, Davies MJ. 24.  2013. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care 36:3411–17 [Google Scholar]
  25. Shah BR, Hux JE, Laupacis A, Zinman B, van Walraven C. 25.  2005. Clinical inertia in response to inadequate glycemic control: Do specialists differ from primary care physicians?. Diabetes Care 28:600–6 [Google Scholar]
  26. McEwen LN, Bilik D, Johnson SL, Halter JB, Karter AJ. 26.  et al. 2009. Predictors and impact of intensification of antihyperglycemic therapy in type 2 diabetes: translating research into action for diabetes (TRIAD). Diabetes Care 32:971–76 [Google Scholar]
  27. Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S. 27.  et al. 2004. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 43:10–17 [Google Scholar]
  28. Roumie CL, Elasy TA, Wallston KA, Pratt S, Greevy RA. 28.  et al. 2007. Clinical inertia: a common barrier to changing provider prescribing behavior. Joint Comm. J. Qual. Patient Saf. 33:277–85 [Google Scholar]
  29. Pittman DG, Fenton C, Chen W, Haffner S, Pendergrass M. 29.  2012. Relation of statin nonadherence and treatment intensification. Am. J. Cardiol. 110:1459–63 [Google Scholar]
  30. Rodondi N, Peng T, Karter AJ, Bauer DC, Vittinghoff E. 30.  et al. 2006. Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus. Ann. Intern. Med. 144:475–84 [Google Scholar]
  31. Erzen D, Carriere KC, Dik N, Mustard C, Roos LL. 31.  et al. 1997. Income level and asthma prevalence and care patterns. Am. J. Respir. Crit. Care Med. 155:1060–65 [Google Scholar]
  32. Habbick BF, Pizzichini MMM, Taylor B, Rennie D, Senthilselvan A, Sears MR. 32.  1999. Prevalence of asthma, rhinitis and eczema among children in 2 Canadian cities: the International Study of Asthma and Allergies in Childhood. CMAJ 160:1824–28 [Google Scholar]
  33. Kattan M, Crain EF, Steinbach S, Visness CM, Walter M. 33.  et al. 2006. A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma. Pediatrics 117:e1095–103 [Google Scholar]
  34. Szefler SJ, Mitchell H, Sorkness CA, Gergen PJ, O'Connor GT. 34.  et al. 2008. Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial. Lancet 372:1065–72 [Google Scholar]
  35. Krym VF, Crawford B, MacDonald RD. 35.  2004. Compliance with guidelines for emergency management of asthma in adults: experience at a tertiary care teaching hospital. CJEM 6:321–26 [Google Scholar]
  36. Cydulka RK, Tamayo-Sarver JH, Wolf C, Herrick E, Gress S. 36.  2005. Inadequate follow-up controller medications among patients with asthma who visit the emergency department. Ann. Emerg. Med. 46:316–22 [Google Scholar]
  37. Ducharme FM, Noya FJ, Allen-Ramey FC, Maiese EM, Gingras J, Blais L. 37.  2012. Clinical effectiveness of inhaled corticosteroids versus montelukast in children with asthma: prescription patterns and patient adherence as key factors. Curr. Med. Res. Opin. 28:111–19 [Google Scholar]
  38. Lougheed MD, Garvey N, Chapman KR, Cicutto L, Dales R. 38.  et al. 2009. Variations and gaps in management of acute asthma in Ontario emergency departments. Chest 135:724–36 [Google Scholar]
  39. 39. Br. Thorac. Soc., Scott. Intercoll. Guidel. Netw 2014. British guideline on the management of asthma. Thorax 69:i1–92 [Google Scholar]
  40. 40. Natl. Heart Lung Blood Inst., Natl. Asthma Educ. Prev. Program 2007. Expert Panel Report 3: guidelines for the diagnosis and management of asthma Rep., Natl. Inst. Health, Bethesda, MD [Google Scholar]
  41. 41. WHO (World Health Organ.) 2013. Burden of COPD Geneva: WHO http://www.who.int/respiratory/copd/burden/en/index.html [Google Scholar]
  42. Murphy SL, Kochanek KD, Xu J, Arias E. 42.  2015. Mortality in the United States, 2014 NCHS Data Brief, Natl. Cent. Health Stat., Hyattsville, MD [Google Scholar]
  43. Cooke CE, Sidel M, Belletti DA, Fuhlbrigge AL. 43.  2012. Review: clinical inertia in the management of chronic obstructive pulmonary disease. COPD 9:73–80 [Google Scholar]
  44. Kaminsky DA, Marcy TW, Bachand M, Irvin CG. 44.  2005. Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians. Respir. Care 50:1639–48 [Google Scholar]
  45. 45. Glob. Initiat. Chronic Obstr. Lung Dis 2016. Global strategy for the diagnosis, management, and prevention of COPD. Rep., Glob. Initiat. Chronic Obstr. Lung Dis. (GOLD). http://goldcopd.org/global-strategy-diagnosis-management-prevention-copd-2016/ [Google Scholar]
  46. Diette GB, Orr P, McCormack MC, Gandy W, Hamar B. 46.  2010. Is pharmacologic care of chronic obstructive pulmonary disease consistent with the guidelines?. Popul. Health Manag. 13:21–26 [Google Scholar]
  47. Heins-Nesvold J, Carlson A, King-Schultz L, Joslyn KE. 47.  2008. Patient identified needs for chronic obstructive pulmonary disease versus billed services for care received. Int. J. Chronic Obstr. Pulm. Dis. 3:415–21 [Google Scholar]
  48. Barr RG, Celli BR, Martinez FJ, Ries AL, Rennard SI. 48.  et al. 2005. Physician and patient perceptions in COPD: the COPD Resource Network Needs Assessment Survey. Am. J. Med. 118:1415e9–17 [Google Scholar]
  49. Chavez PC, Shokar NK. 49.  2009. Diagnosis and management of chronic obstructive pulmonary disease (COPD) in a primary care clinic. COPD 6:446–51 [Google Scholar]
  50. Aujoulat I, Jacquemin P, Rietzschel E, Scheen A, Trefois P. 50.  et al. 2014. Factors associated with clinical inertia: an integrative review. Adv. Med. Educ. Pract. 5:141–47 [Google Scholar]
  51. Byrnes PD. 51.  2011. Why haven't I changed that? Therapeutic inertia in general practice. Aust. Fam. Phys. 40:24–28 [Google Scholar]
  52. Byrne D, O'Connor L, Jennings S, Bennett K, Murphy AW. 52.  2015. A survey of GPs awareness and use of risk assessment tools and cardiovascular disease prevention guidelines. Ir. Med. J. 108:204–7 [Google Scholar]
  53. Kiberd J, Panek R, Kiberd B. 53.  2007. Strategies to reduce clinical inertia in hypertensive kidney transplant recipients. BMC Nephrol 8:10 [Google Scholar]
  54. Nicolucci A, Rossi MC. 54.  2008. Incretin-based therapies: a new potential treatment approach to overcome clinical inertia in type 2 diabetes. Acta Biomed. 79:184–91 [Google Scholar]
  55. Redon J, Coca A, Lazaro P, Aguilar MD, Cabanas M. 55.  et al. 2010. Factors associated with therapeutic inertia in hypertension: validation of a predictive model. J. Hypertens. 28:1770–77 [Google Scholar]
  56. Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M. 56.  et al. 1998. Inadequate management of blood pressure in a hypertensive population. N. Engl. J. Med. 339:1957–63 [Google Scholar]
  57. Nau DP, Mallya U. 57.  2005. Sex disparity in the management of dyslipidemia among patients with type 2 diabetes mellitus in a managed care organization. Am. J. Manag. Care 11:69–73 [Google Scholar]
  58. Howes F, Hansen E, Williams D, Nelson M. 58.  2010. Barriers to diagnosing and managing hypertension: a qualitative study in Australian general practice. Aust. Fam. Phys. 39:511–16 [Google Scholar]
  59. Grant R, Adams AS, Trinacty CM, Zhang F, Kleinman K. 59.  et al. 2007. Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management. Diabetes Care 30:807–12 [Google Scholar]
  60. Reach G. 60.  2008. Patient non-adherence and healthcare-provider inertia are clinical myopia. Diabetes Metab 34:382–85 [Google Scholar]
  61. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyorala K, Keil U. 61.  2009. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 373:929–40 [Google Scholar]
  62. Handler J, Lackland DT. 62.  2011. Translation of hypertension treatment guidelines into practice: a review of implementation. J. Am. Soc. Hypertens. 5:197–207 [Google Scholar]
  63. Hyman DJ, Pavlik VN. 63.  2000. Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch. Intern. Med. 160:2281–86 [Google Scholar]
  64. Foster JA, Yawn BP, Maziar A, Jenkins T, Rennard SI, Casebeer L. 64.  2007. Enhancing COPD management in primary care settings. MedGenMed 9:24 [Google Scholar]
  65. Barth JH, Misra S, Aakre KM, Langlois MR, Watine J. 65.  et al. 2015. Why are clinical practice guidelines not followed?. Clin. Chem. Lab. Med. 54:1133–39 [Google Scholar]
  66. el-Kebbi IM, Ziemer DC, Gallina DL, Dunbar V, Phillips LS. 66.  1999. Diabetes in urban African-Americans. XV. Identification of barriers to provider adherence to management protocols. Diabetes Care 22:1617–20 [Google Scholar]
  67. Bramlage P, Thoenes M, Kirch W, Lenfant C. 67.  2007. Clinical practice and recent recommendations in hypertension management—reporting a gap in a global survey of 1259 primary care physicians in 17 countries. Curr. Med. Res. Opin. 23:783–91 [Google Scholar]
  68. Steinman MA, Fischer MA, Shlipak MG, Bosworth HB, Oddone EZ. 68.  et al. 2004. Clinician awareness of adherence to hypertension guidelines. Am. J. Med. 117:747–54 [Google Scholar]
  69. Miller WR, Rollnick S. 69.  2012. Motivational Interviewing: Helping People Change New York: Guilford Press [Google Scholar]
  70. Bandura A. 70.  1986. Social Foundations of Thought and Action: A Social Cognitive Theory Englewood Cliffs, NJ: Prentice-Hall, Inc. [Google Scholar]
  71. Perez X, Wisnivesky JP, Lurslurchachai L, Kleinman LC, Kronish IM. 71.  2012. Barriers to adherence to COPD guidelines among primary care providers. Respir. Med. 106:374–81 [Google Scholar]
  72. Davis D, Galbraith R. 72.  2009. Continuing medical education effect on practice performance: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest 135:Suppl.42S–48S [Google Scholar]
  73. Mostofian F, Ruban C, Simunovic N, Bhandari M. 73.  2015. Changing physician behavior: What works?. Am. J. Manag. Care 21:75–84 [Google Scholar]
  74. Yen BM. 74.  2006. Engaging physicians to change practice. J. Clin. Outcomes Manag. 13:103–10 [Google Scholar]
  75. Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ. 75.  et al. 2005. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 293:1223–38 [Google Scholar]
  76. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. 76.  2005. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 330:765 [Google Scholar]
  77. Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. 77.  2011. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst. Rev. 2011:CD009255 [Google Scholar]
  78. Davis DA, Taylor-Vaisey A. 78.  1997. Translating guidelines into practice: a systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ 157:408–16 [Google Scholar]
  79. Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD. 79.  2006. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual. Saf. Health Care 15:433–36 [Google Scholar]
  80. Kazdin AE. 80.  2012. Behavior Modification in Applied Settings Long Grove, IL: Waveland Press [Google Scholar]
  81. Deci EL, Ryan RM. 81.  2002. Handbook of Self-Determination Research Rochester, NY: Univ. Rochester Press [Google Scholar]
  82. Rollnick S, Miller WR, Butler CC, Aloia MS. 82.  2008. Motivational Interviewing in Health Care: Helping Patients Change Behavior New York: Guilford Press [Google Scholar]
  83. Barratt A. 83.  2008. Evidence based medicine and shared decision making: the challenge of getting both evidence and preferences into health care. Patient Educ. Couns. 73:407–12 [Google Scholar]
  84. Joosten EAG, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CPF, de Jong CAJ. 84.  2008. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother. Psychosom. 77:219–26 [Google Scholar]
  85. Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW. 85.  et al. 2010. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am. J. Respir. Crit. Care Med. 181:566–77 [Google Scholar]
  86. Rogers EM. 86.  1995. Lessons for guidelines from the diffusion of innovations. Joint Comm. J. Qual. Improv. 21:324–28 [Google Scholar]
  87. Grilli R, Lomas J. 87.  1994. Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med. Care 32:202–13 [Google Scholar]
  88. 88. Guidel. Int. Netw 2016. About G-I-N: Introduction. Perthshire, Scotl.: Guidel. Int. Netw http://www.g-i-n.net/about-g-i-n/introduction [Google Scholar]
  89. Ollenschläger G, Marshall C, Qureshi S, Rosenbrand K, Burgers J. 89.  et al. 2004. Improving the quality of health care: using international collaboration to inform guideline programmes by founding the Guidelines International Network (G-I-N). Qual. Saf. Health Care 13:455–60 [Google Scholar]
  90. Watson M, Gunnell D, Peters T, Brookes S, Sharp D. 90.  2001. Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice: a randomised controlled trial. J. Health Serv. Res. Policy 6:207–13 [Google Scholar]
  91. Giguère A, Légaré F, Grimshaw J, Turcotte S, Fiander M. 91.  et al. 2012. Printed educational materials: Effects on professional practice and healthcare outcomes. Cochrane Database Syst. Rev. 2012:CD004398 [Google Scholar]
  92. Majumdar SR, Tsuyuki RT, McAlister FA. 92.  2007. Impact of opinion leader–endorsed evidence summaries on the quality of prescribing for patients with cardiovascular disease: a randomized controlled trial. Am. Heart J. 153:22e1–8 [Google Scholar]
  93. Flodgren G, Parmelli E, Doumit G, Gattellari M, O'Brien MA. 93.  et al. 2011. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst. Rev. 2011:CD000125 [Google Scholar]
  94. Mehler PS, Krantz MJ, Lundgren RA, Estacio RO, MacKenzie TD. 94.  et al. 2005. Bridging the quality gap in diabetic hyperlipidemia: a practice-based intervention. Am. J. Med. 118:1414.e13–19 [Google Scholar]
  95. O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J. 95.  et al. 2007. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst. Rev. 2007:CD000409 [Google Scholar]
  96. Brown R, Bratton SL, Cabana MD, Kaciroti N, Clark NM. 96.  2004. Physician asthma education program improves outcomes for children of low-income families. Chest 126:369–74 [Google Scholar]
  97. Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O'Brien MA. 97.  et al. 2009. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst. Rev. 2009:CD003030 [Google Scholar]
  98. Foster JM, Hoskins G, Smith B, Lee AJ, Price D, Pinnock H. 98.  2007. Practice development plans to improve the primary care management of acute asthma: randomised controlled trial. BMC Fam. Pract. 8:23 [Google Scholar]
  99. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J. 99.  et al. 2012. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst. Rev. 2012:CD000259 [Google Scholar]
  100. Magruder-Habib K, Zung WW, Feussner JR. 100.  1990. Improving physicians' recognition and treatment of depression in general medical care: results from a randomized clinical trial. Med. Care 28:239–50 [Google Scholar]
  101. Hemens BJ, Holbrook A, Tonkin M, Mackay JA, Weise-Kelly L. 101.  et al. 2011. Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review. Implementation Sci. 6:89 [Google Scholar]
  102. Roshanov PS, Fernandes N, Wilczynski JM, Hemens BJ, You JJ. 102.  et al. 2013. Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. BMJ 346:f657 [Google Scholar]
  103. Ziemer DC, Doyle JP, Barnes CS, Branch WT Jr., Cook CB. 103.  et al. 2006. An intervention to overcome clinical inertia and improve diabetes mellitus control in a primary care setting: Improving Primary Care of African Americans with Diabetes (IPCAAD) 8. Arch. Intern. Med. 166:507–13 [Google Scholar]
  104. Medves J, Godfrey C, Turner C, Paterson M, Harrison M. 104.  et al. 2010. Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. Int. J. Evid.-Based Healthc. 8:79–89 [Google Scholar]
  105. Feldman RD, Zou GY, Vandervoort MK, Wong CJ, Nelson SA, Feagan BG. 105.  2009. A simplified approach to the treatment of uncomplicated hypertension: a cluster randomized, controlled trial. Hypertension 53:646–53 [Google Scholar]
  106. Fairbrother G, Hanson KL, Friedman S, Butts GC. 106.  1999. The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates. Am. J. Public Health 89:171–75 [Google Scholar]
  107. Scales DC, Dainty K, Hales B, Pinto R, Fowler RA. 107.  et al. 2011. A multifaceted intervention for quality improvement in a network of intensive care units: a cluster randomized trial. JAMA 305:363–72 [Google Scholar]
  108. Beck AT, Rush AJ, Shaw BF, Emery G. 108.  1979. Cognitive Therapy of Depression New York: Guilford Press [Google Scholar]
  109. Janz NK, Becker MH. 109.  1984. The health belief model: a decade later. Health Educ. Behav. 11:1–47 [Google Scholar]
  110. Prochaska JO, Velicer WF. 110.  1997. The transtheoretical model of health behavior change. Am. J. Health Promot. 12:38–48 [Google Scholar]
  111. Ajzen I. 111.  1991. The theory of planned behavior. Organ. Behav. Hum. Decis. Process. 50:179–211 [Google Scholar]
  112. Veazie PJ, Qian F. 112.  2011. A role for regulatory focus in explaining and combating clinical inertia. J. Eval. Clin. Pract. 17:1147–52 [Google Scholar]

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