Therapeutic inertia in the management of hyperlipidaemia in type 2 diabetic patients: a cross-sectional study in the primary care setting

Man, FY; Chen, Catherine XR; Lau, YY; Chan, King

doi:10.12809/hkmj154667

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…A small number of physicians believe that the absence of more energetic treatment causes poorly regulated glycemia by patients. It is well known that judgements of physicians about wishes, motivation, and readiness of patients for change can be wrong and are very often connected to clinical inertia [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Indeed, this threshold effect was also found to be related to the inertia of treating hyperglycemia and hyperlipidaemia in T2DM patients (22,17).…”

Section: Discussionmentioning

confidence: 99%

“…TI has become increasingly acknowledged as a major impediment for CVD risk factor control. Indeed, in another study carried out by the author's research team, TI has been present in lipid management in over 60% of diabetes patients with dyslipidemia (17).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Inertia in the Management of Proteinuria Among Type 2 Diabetes Patients in Hong Kong Primary Care Setting: Prevalence and Associated Risk Factors

Chan

Chen

2020

Preprint

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Background: Proteinuria is a well-known predictor of poor renal and cardiovascular outcomes in T2DM patientsMethods: Objectives: To explore the prevalence of Therapeutic inertia (TI) on proteinuria management among T2DM patients in primary care and possible patients’ and doctors’ factors.Study design: Cross-sectional studySubjects: T2DM patients with microalbuminuria and macroalbuminuria from 1/1/2014 to 31/12/2015.Outcome assessments: The prevalence of TI on proteinuria management and its association patients’ factors and the working profile of the attending doctors.Results: 5, 163 (26.4%) patients had diabetic nephropathy (DMN) with micro- or macroalbuminuria. Among the sampled 385 patients with DMN, TI was found to be 40.3%. Doctor factors for higher TI rate include male sex and doctors with longer duration of clinical practice and who have never received any form of Family Medicine training. Patients factors include lower average systolic (SBP) and diastolic blood pressure reading. Patients’ SBP reading and microalbuminuria were negative association factor whereas doctor’s year of clinical practice being over 21 years and patients being treated with submaximal dose of medication were positive association factors to TI. Conclusions: TI is commonly present on proteinuria management among T2DM patients managed in the primary care. Patient’s systolic blood pressure reading, microalbuminuria level, Dr’s year of clinical practice and dose of ACEI/ARB were found to be associated with the presence of TI. Further study on the barriers and strategies to combat TI is needed to improve the clinical outcome among T2DM patients.

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“…As there are no similar studies carried out internationally or locally on this particular topic, direct comparisons with other studies are not possible. Having said so, this TI rate in proteinuria management was much higher than the TI rate in glycaemic control (29–33%) among T2DM patients [ 22 , 23 ], although lower than the TI rate in blood pressure (63.3–68%) [ 24 ] and lipid control (66–80%) [ 25 ] carried out by various research teams. This relatively high TI rate should alert family physicians the importance of proteinuria control among T2DM patients and make concerted effort to combat the TI.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors

Chan

Chen

2021

BMC Fam Pract

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Background Therapeutic inertia (TI), defined as physicians’ failure to increase therapy when treatment goals are unmet, is an impediment to chronic disease management. This study aimed to identify the prevalence of TI in proteinuria management among T2DM patients managed in primary care settings and to explore possible associating factors. Methods This was a cross-sectional study. T2DM patients with proteinuria (either microalbuminuria or macroalbuminuria) and had been followed up in 7 public primary care clinics of the Hospital Authority of Hong Kong from 1 Jan, 2014 to 31 Dec, 2015 were included. The prevalence of TI in proteinuria management and its association with patients’ demographic and clinical parameters and the working profile of the attending doctors were explored. Student’s t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics. Results Among the 22,644 T2DM patients identified in the case register, 5163 (26.4%) patients were found to have proteinuria. Among the sampled 385 T2DM patients with proteinuria, TI was identified in 155 cases, with a prevalence rate of 40.3%. Male doctor, doctor with longer duration of clinical practice and have never received any form of Family Medicine training were found to have a higher TI. Patients with microalbuminuria range and lower systolic and diastolic blood pressure (BP) were also found to have higher TI. Logistic regression study revealed that patients’ systolic BP level and microalbuminuria range of proteinuria were negatively associated with the presence of TI, whereas doctor’s year of clinical practice being over 20 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI. Conclusions TI is commonly present in proteinuria management among T2DM patients, with a prevalence of 40.3% in primary care. Systolic BP and microalbuminuria range of urine ACR were negatively associated with the presence of TI, whereas submaximal ACEI/ARB dose and doctors practicing over 20 years were positively associated with the presence of TI. Further studies exploring the strategies to combat TI are needed to improve the clinical outcome of T2DM patients.

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Therapeutic inertia in the management of hyperlipidaemia in type 2 diabetic patients: a cross-sectional study in the primary care setting

Cited by 5 publications

References 21 publications

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

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

Therapeutic Inertia in the Management of Proteinuria Among Type 2 Diabetes Patients in Hong Kong Primary Care Setting: Prevalence and Associated Risk Factors

Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors

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