Table 2 How HOME BP addresses clinical inertia in prescribing hypertension medication

Clinical inertia can occur because practitioners are not confident that the patient’s raised clinic reading is an accurate representation of their normal day-to-day blood pressure (e.g. could be white coat hypertension) [38] and so they expect that making a medication change might be unnecessary or unsafe.

Home BP overcomes this problem by enabling practitioners to base medication decisions on more reliable evidence – the mean of home blood pressure readings recorded every day for one week out of every month. If readings are above target for two consecutive months then this is strong evidence that a medication change is required.

Clinical inertia can also occur because practitioners are concerned that increasing medication may be disliked by patients and could negatively impact on the patient-practitioner relationship.

At the beginning of the HOME BP programme patients learn about the benefits of making medication changes if blood pressure is above target. After this patients meet with the practitioner to agree which medication changes would be most suitable if their blood pressure remains above target. The practitioner can therefore be assured that patients are in agreement with the practitioner’s decision to prescribe if they do need to implement a medication change.

Clinical inertia can also occur when practitioners are not sure which drugs to implement within a consultation with a patient whose blood pressure is raised [38].

Deciding medication changes in advance of their implementation gives practitioners more time to decide which medication changes might be most suitable and so may overcome this problem. Practitioners are shown brief modelled examples of a Prescriber choosing drugs for a patient in HOME BP, as well as guidance from NICE on choosing medications for hypertension [9].

A final important reason for clinical inertia appears to be clinicians not understanding treatment targets, or believing that the patient is ‘close enough’ when they are above target [5].

This is addressed in HOME BP by the programme emailing Prescribers to alert them when a patient’s blood pressure remains above target and medication change is required.