Clinical Inertia in Type 2 Diabetes Patients in Primary Health Care Clinics in Central Bosnia

Abstract

BackgroundThe goal of this research was to determine the frequency of clinical inertia of general practice physicians in the region of Central Bosnia in healthcare for type 2 diabetes patients, to analyze characteristics of patients and physicians, as well as glucose regulation during clinical inertia, and, on the basis of these indicators, give recommendations for reducing clinical inertia.Material/MethodsThis study included 29 doctors, family physicians, or general practitioners, who collected data in a total sample of 541 type 2 diabetes mellitus patients from July to November 2017. The research was conducted using 2 questionnaires. The glucose concentration in plasma and the percentage of glycosylated hemoglobin (HbA1c) were determined. Concertation of cholesterol, triglycerides, AST, and ALT were also measured. After the collection, new data were processed and the degree of clinical inertia was determined.ResultLevels of HbA1c ranged from 4.3% to 13.0%, and 38.4% of all patients had HbA1c level higher than 7.5%, while 8.3% of them had HbA1c level 9.0% or higher. Clinical inertia in our research was 12.6% out of all patients and 48.2% were referred to a specialist by their doctor.ConclusionsFor better regulation of glycemia and reduction of clinical inertia with type 2 diabetes patients, more specialized training is needed for selected physicians. Strengthening of primary healthcare and encouraging doctors to perform procedures can contribute to better outcomes of treatment, lower clinical inertia, and better education of patients.

Prevalence and Associated Factors of Delayed Diagnosis of Type 2 Diabetes Mellitus in a Tertiary Hospital: A Retrospective Cohort Study

“…The delayed diagnosis might be not related specifically to the presence of hypertension but probably to the determinants of the overall cardiovascular comorbidities. This is consistent with the results of a study in Bosnia, wherein the patients with high blood pressure and comorbidities had a higher risk of clinical inertia because physicians paid more attention to healthy patients and those who were thought to be more disciplined [ 24 ]. Additionally, a meta-analysis by Aujoulat et al showed that clinical inertia was more common in patients with comorbidities [ 25 ].…”

“…This result is consistent with that of the study in the U.S., whereby physicians with less experience (<10 years of practice) provided appropriate diagnoses because they were updated with the guidelines and had recent publication knowledge [ 4 ]. Moreover, the study in Bosnia found that physicians not considering the clinical guidelines for treatment could cause delayed diagnosis [ 24 ]. Additionally, physicians with insufficient clinical knowledge provided inappropriate treatment caused by the misinterpretation of the guidelines or disagreement with guidelines that define HbA1c ≥6.5% as a diagnostic criterion but HbA1c <7% as the treatment goal [ 8 ].…”

Drug Utilization Study of Antidiabetic Drugs in Patients Attending Geriatric Outpatient Department in Tertiary Care Hospital

“…When these physicians are confronted in such situations, the phenomenon of “clinical inertia” is evident. It is referred to as “A consultation in which a change in treatment based on a diabetes-related variable was indicated but did not occur” [ 28 , 29 ]. This leads to inappropriate prescribing and improper use of these medications.…”

Effect of Clinical Inertia on Diabetes Complications among Individuals with Type 2 Diabetes: A Retrospective Cohort Study

“…Clinical inertia is defined as the failure to enhance drug therapy when clinically indicated [20]. The extent of clinical inertia in diabetes management ranges from 8.4 to 70%, depending on the research method and the country where the study was performed [21]. In the United States, the prevalence of clinical inertia ranges from 28 to 73% [22].…”