Family Physician Clinical Inertia in Glycemic Control among Patients with Type 2 Diabetes

Abstract

BackgroundMany patients with diabetes do not achieve target values. One of the reasons for this is clinical inertia. The correct explanation of clinical inertia requires a conjunction of patient with physician and health care system factors. Our aim was to determine the rate of clinical inertia in treating diabetes in primary care and association of patient, physician, and health care setting factors with clinical inertia.Material/MethodsThis was a national, multicenter, observational, cross-sectional study in primary care in Croatia. Each family physician (FP) provided professional data and collected clinical data on 15–25 type 2 diabetes (T2DM) patients. Clinical inertia was defined as a consultation in which treatment change based on glycated hemoglobin (HbA1c) levels was indicated but did not occur.ResultsA total of 449 FPs (response rate 89.8%) collected data on 10275 patients. Mean clinical inertia per FP was 55.6% (SD ±26.17) of consultations. All of the FPs were clinically inert with some patients, and 9% of the FPs were clinically inert with all patients. The main factors associated with clinical inertia were: higher percentage of HbA1c, oral anti-diabetic drug initiated by diabetologist, increased postprandial glycemia and total cholesterol, physical inactivity of patient, and administration of drugs other than oral antidiabetics.ConclusionsClinical inertia in treating patients with T2DM is a serious problem. Patients with worse glycemic control and those whose therapy was initiated by a diabetologist experience more clinical inertia. More research on causes of clinical inertia in treating patients with T2DM should be conducted to help achieve more effective diabetes control.

Glycemic Control and Prevalence of Chronic Kidney Disease in Type‑2 Diabetes Mellitus Patients at Primary Healthcare Centers in Yogyakarta Province 2015

“…28 Hal ini sesuai dengan hasil studi Lang dkk yang menunjukkan bahwa hanya 24% pasien dengan nilai kontrol glikemik buruk yang mendapatkan pengelolaan DM intensif di sarana pelayanan dokter keluarga. 29 Perolehan jenis parameter kontrol glikemik yang tidak seragam merupakan bagian keterbatasan pada penelitian ini, namun dengan hasil korelasi antar ketiga parameter yang digunakan kuat (r>0,6), sehingga dapat digunakan sebagai pendekatan nilai kontrol glikemik di tempat penelitian.…”

Assessment of the relationship between diabetes treatment intensification and quality measure performance using electronic medical records

“…Several factors are associated with diabetes treatment inertia, which is defined as failure to intensify pharmacotherapy in accordance with clinical guidelines. Recent studies using primary care populations suggest that complexity of treatment [ 11 ], patient medication adherence [ 12 ], HbA1C level [ 13 ], specialty of the physician initiating the therapy [ 14 ], physician experience level [ 13 ], and other provider-, patient- and system-level barriers [ 15 ] may be linked to diabetes treatment inertia. While no study has assessed the direct relationship between timely treatment intensification and diabetes quality measure performance, it is reasonable to expect that timely treatment intensification would contribute to greater likelihood of achievement of HbA1C quality performance goals as measured by HbA1C control.…”

Supporting general practitioner-based care for poorly controlled type 2 diabetes mellitus (the DECIDE study): feasibility study and protocol for a pilot cluster randomised controlled trial

“…Clinical inertia is one cause of poor control of T2DM and is defined as a failure to apply evidence-based guidance and intensify treatment, and it is an impediment to efficient care [ 7 – 9 ]. The need to intensify therapies in an appropriate and timely manner is a prerequisite to improving the management of T2DM [ 10 – 15 ]. Significant delays in the intensification of oral hypoglycaemic, anti-hypertensive and lipid-lowering medications have been demonstrated [ 2 , 16 – 20 ].…”