For last week’s practice question, we quizzed participants on childhood trauma during diabetes visits. 38% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it by clicking here.
AR is a 22-year-old with type 2 diabetes and persistent BP readings of 140/90 or greater for the past 6 months. For medications, they are on metformin 850mg twice daily with an A1C of 6.9%. You have suggested several times to start AR on a BP lowering medication, but the medical provider keeps saying, “let’s focus on diet and activity before starting a blood pressure medication.”
What is the best response?
- A. Place a copy of the ADA hypertension guidelines in the providers inbox.
- B. Set up meeting with management to implement best practice guidelines.
- C. Encourage AR to self-advocate for better BP management.
- D. Have AR get a BP machine and bring a log of BP reading to next medical appointment
Getting to the Best Answer
Answer A is incorrect. 11.10% chose this answer: Place a copy of the ADA hypertension guidelines in the providers inbox.” While sharing the guidelines may increase awareness, this approach is unlikely to change practice behavior. Simply providing educational materials does not address the underlying causes of therapeutic inertia, such as workflow issues, competing priorities, or provider habits. More active quality improvement strategies are generally more effective than distributing guidelines alone.
Answer B is correct. 37.78% of you chose this answer, “Set up meeting with management to implement best practice guidelines.” Great Job, this is the best response! The medical provider has demonstrated therapeutic inertia by delaying treatment despite persistent hypertension for six months. According to the American Diabetes Association (ADA) Standards of Care, adults with diabetes and confirmed hypertension (blood pressure ≥140/90 mmHg) need receive prompt treatment with lifestyle modification and antihypertensive medication. Implementing evidence-based clinical protocols or standardized treatment pathways can reduce therapeutic inertia and improve outcomes across the practice, making this the most effective systems-level intervention.
Answer C is incorrect. 20.32% of respondents chose this: “Encourage AR to self-advocate for better BP management.” Empowering AR to participate in shared decision-making is appropriate and may help facilitate a productive conversation with the provider. However, this places the responsibility on the AR rather than addressing the provider’s repeated failure to initiate evidence-based treatment. Although patient advocacy is important, it is not the best solution to persistent therapeutic inertia.
Finally, Answer D is incorrect. 30.80% chose this answer, “Have AR get a BP machine and bring a log of BP reading to next medical appointment.” Home blood pressure monitoring is an excellent strategy for confirming hypertension, detecting white coat hypertension, and monitoring response to therapy. However, in this case, the stem states that AR has had persistent blood pressure readings of 140/90 mmHg or greater for the past six months, indicating that sufficient evidence already exists to support treatment. Asking for additional blood pressure logs delays appropriate therapy and may contribute to further therapeutic inertia.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to Learn More about this Question?
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