Understanding Clinical Inertia in Diabetes

Veettil, Raveendran Arkiath

doi:10.1055/s-0039-1694300

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…Evidence from community-based, randomised controlled trials conducted in resource-rich settings such as the UK and Hong Kong showed that “real-world” prevention programmes may not always lead to successful reduction in BP, blood glucose, and other cardiovascular risk factors ( 38 , 39 ). Hence, numerous efforts are still needed to translate trials from research-based settings that are effective to daily practice where intensive efforts at CVD risk reduction are less likely to be sustained regularly due to the possible co-existence of clinical inertia and physician burnout ( 40 , 41 ).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention

Cheng

et al. 2023

Front. Cardiovasc. Med.

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AimsTo assess longitudinal changes in blood pressure (BP) and fasting plasma glucose (FPG) in primary care patients with concomitant hypertension and type 2 diabetes mellitus (T2DM), and to explore factors associated with patients' inability to improve BP and FPG at follow-up.MethodsWe constructed a closed cohort in the context of the national basic public health (BPH) service provision in an urbanised township in southern China. Primary care patients who had concomitant hypertension and T2DM were retrospectively followed up from 2016 to 2019. Data were retrieved electronically from the computerised BPH platform. Patient-level risk factors were explored using multivariable logistic regression analysis.ResultsWe included 5,398 patients (mean age 66 years; range 28.9 to 96.1 years). At baseline, almost half [48.3% (2,608/5,398)] of patients had uncontrolled BP or FPG. During follow-up, more than one-fourth [27.2% (1,467/5,398)] of patients had no improvement in both BP and FPG. Among all patients, we observed significant increases in systolic BP [2.31 mmHg, 95% confidence interval (CI): 2.04 to 2.59, p < 0.001], diastolic BP (0.73 mmHg, 0.54 to 0.92, p < 0.001), and FPG (0.12 mmol/l, 0.09 to 0.15, p < 0.001) at follow-up compared to baseline. In addition to changes in body mass index [adjusted odds ratio (aOR)=1.045, 1.003 to 1.089, p = 0.037], poor adherence to lifestyle advice (aOR = 1.548, 1.356 to 1.766, p < 0.001), and unwillingness to actively enrol in health-care plans managed by the family doctor team (aOR = 1.379, 1.128 to 1.685, p = 0.001) were factors associated with no improvement in BP and FPG at follow-up.ConclusionA suboptimal control of BP and FPG remains an ongoing challenge to primary care patients with concomitant hypertension and T2DM in real-world community settings. Tailored actions aiming to improve patients' adherence to healthy lifestyles, expand the delivery of team-based care, and encourage weight control should be incorporated into routine healthcare planning for community-based cardiovascular prevention.

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Section: Discussionmentioning

confidence: 99%

Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention

Cheng

et al. 2023

Front. Cardiovasc. Med.

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“…Previous documents have reported the inability or failure of physicians to initiate or intensify therapy when a more aggressive course is recommended by guidelines, known as ‘clinical inertia’ in routine practice [ 38 ]. This could exist in all stages of disease management, including the beginning of lifestyle changes and strengthening of treatment [ 39 ]. Interestingly, our findings showed a positive correlation between physician’s higher education level and perceived greater healthcare needs in follow-up care, which may be a result of proper knowledge and understanding of best practice acquired from better education.…”

Section: Discussionmentioning

confidence: 99%

Follow-up care delivery in community-based hypertension and type 2 diabetes management: a multi-centre, survey study among rural primary care physicians in China

Wang

et al. 2021

BMC Fam Pract

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Background Follow-up care is crucial but challenging for disease management particularly in rural areas with limited healthcare resources and clinical capacity, yet few studies have been conducted from the perspective of rural primary care physicians (PCPs). We assessed the frequency of follow-up care delivered by rural PCPs for hypertension and type 2 diabetes – the two most common long-term conditions. Methods We conducted a multi-centre, self-administered survey study built upon existing general practice course programmes for rural PCPs in four provinces. Information on follow-up care delivery were collected from rural PCPs attending centralised in-class teaching sessions using a set of close-ended, multiple choice questions. Binary logistic regression analysis was performed to examine physician-level factors associated with non-attainment of the target frequency of follow-up care for hypertension and type 2 diabetes, respectively. The final sample consisted of rural PCPs from 52 township-level regions. The Complex Samples module was used in the statistical analysis to account for the multistage sample design. Results The overall response rate was 91.4%. Around one fifth of PCPs in rural practices did not achieve the target frequency of follow-up care delivery (18.7% for hypertension; 21.6% for type 2 diabetes). Higher education level of physicians, increased volume of daily patients seen, and no provision of home visits were risk factors for non-attainment of the target frequency of follow-up care for both conditions. Moreover, village physicians with less working experiences tended to have less frequent follow-up care delivery in type 2 diabetes management. Conclusions Efforts that are solely devoted to enhancing rural physicians’ education may not directly translate into strong motivation and active commitment to service provision given the possible existence of clinical inertia and workload-related factors. Risk factors identified for target non-attainment in the follow-up care delivery may provide areas for capacity building programmes in rural primary care practice.

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“…In simple words, inertia means a tendency to remain unchanged, and when it comes to clinical practice, clinical inertia simply means a tendency of the clinician to remain unchanged in the diagnostic, preventive, and therapeutic aspects even when the change is warranted. [ 1 , 2 ]…”

Section: Introductionmentioning

confidence: 99%

Clinical Inertia: A Wider Perspective and Proposed Classification Criteria

Raveendran

2023

Indian Journal of Endocrinology and Metabolism

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Clinical inertia is very common in day-to-day practice, and the factors contributing to that can be physician-related, patient-related, or health-care-related. Clinical inertia is commonly described in chronic asymptomatic illness. We searched the PubMed and Scopus databases for original articles and reviews. Based on the search result, in this review article, we redefine various terminologies to avoid confusion and propose classification criteria for the early identification of clinical inertia. Clinical inertia is also present in acute illness and in symptomatic disease. Early identification of clinical inertia is difficult because of very vague terminologies which have been used interchangeably as well as because of the lack of definitive classification criteria. In this article, we redefine clinical inertia and propose criteria for early identification, which will be useful for both clinicians and academicians. This review will help clinicians to identify and rectify various aspects of clinical inertia.

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Understanding Clinical Inertia in Diabetes

Cited by 5 publications

References 11 publications

Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention

Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention

Follow-up care delivery in community-based hypertension and type 2 diabetes management: a multi-centre, survey study among rural primary care physicians in China

Clinical Inertia: A Wider Perspective and Proposed Classification Criteria

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