Will Running the Numbers First Violate the Principles of Patient-Centered Care?
Authors: Sandeep Vijan
Journal: Annals of Internal Medicine (2008)

Letters2 December 2008Will Running the Numbers First Violate the Principles of Patient-Centered Care?Sandeep Vijan, MD, MS, Rodney A. Hayward, MD, and Peter Ubel, MDSandeep Vijan, MD, MSFrom Veterans Affairs Ann Arbor Healthcare System Health Services Research & Development, Ann Arbor, MI 48105., Rodney A. Hayward, MDFrom Veterans Affairs Ann Arbor Healthcare System Health Services Research & Development, Ann Arbor, MI 48105., and Peter Ubel, MDFrom Veterans Affairs Ann Arbor Healthcare System Health Services Research & Development, Ann Arbor, MI 48105.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-11-200812020-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their recent editorial, Phillips and Twombly (1) suggest that clinical inertia is easily overcome if providers "run the numbers first and deal with blood pressure and glucose before asking about other problems." Although managing vascular risk factors is important in reducing the risk for diabetes complications, their approach dramatically oversimplifies the realities of clinical care.Kerr and colleagues (2) show that clinician and patient uncertainty around management of blood pressure is an important determinant of treatment decisions. Uncertainty can take many forms, from belief in the level of evidence supporting guidelines to concern about side effects ...References1. Phillips LS, Twombly JG. It's time to overcome clinical inertia [Editorial]. Ann Intern Med. 2008;148:783-5. [PMID: 18490691] LinkGoogle Scholar2. Kerr EA, Zikmund-Fisher BJ, Klamerus ML, Subramanian U, Hogan MM, Hofer TP. The role of clinical uncertainty in treatment decisions for diabetic patients with uncontrolled blood pressure. Ann Intern Med. 2008;148:717-27. [PMID: 18490685] LinkGoogle Scholar3. Vijan S, Hayward RA. Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann Intern Med. 2003;138:593-602. [PMID: 12667032] LinkGoogle Scholar4. Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144:884-93. [PMID: 16785477] LinkGoogle Scholar5. Glasziou PP, Irwig L, Heritier S, Simes RJ, Tonkin A; LIPID Study Investigators. Monitoring cholesterol levels: measurement error or true change? Ann Intern Med. 2008;148:656-61. [PMID: 18458278] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Veterans Affairs Ann Arbor Healthcare System Health Services Research & Development, Ann Arbor, MI 48105.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTreatment of Hypertension in Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice of Agents, and Setting Priorities in Diabetes Care Sandeep Vijan and Rodney A. Hayward Dogma Disputed: Can Aggressively Lowering Blood Pressure in Hypertensive Patients with Coronary Artery Disease Be Dangerous? Franz H. Messerli , Giuseppe Mancia , C. Richard Conti , Ann C. Hewkin , Stuart Kupfer , Annette Champion , Rainer Kolloch , Athanase Benetos , and Carl J. Pepine Monitoring Cholesterol Levels: Measurement Error or True Change? Paul P. Glasziou , Les Irwig , Stephane Heritier , R. John Simes , Andrew Tonkin , and The Role of Clinical Uncertainty in Treatment Decisions for Diabetic Patients with Uncontrolled Blood Pressure Eve A. Kerr , Brian J. Zikmund-Fisher , Mandi L. Klamerus , Usha Subramanian , Mary M. Hogan , and Timothy P. Hofer It's Time to Overcome Clinical Inertia Lawrence S. Phillips and Jennifer G. Twombly Will Running the Numbers First Violate the Principles of Patient-Centered Care? Robert C. Sherrick Will Running the Numbers First Violate the Principles of Patient-Centered Care? Sam F. Carter Will Running the Numbers First Violate the Principles of Patient-Centered Care? Lawrence S. Phillips and Jennifer G. Twombly Will Running the Numbers First Violate the Principles of Patient-Centered Care? Cynthia M. Boyd and Bruce Leff Metrics 2 December 2008Volume 149, Issue 11Page: 839KeywordsBlood pressureCholesterolEndocrinologyGlucoseHypertensionMedical risk factorsPrimary care physiciansRunningSub-specialty careSystolic pressure ePublished: 2 December 2008 Issue Published: 2 December 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...