Clinical inertia in general practice: widespread and related to the outcome of diabetes care.
OBJECTIVE
Clinical inertia is considered a major barrier to better care. We assessed its prevalence, predictors and associations with the intermediate outcomes of diabetes care.


METHODS
Baseline and follow-up data of a Dutch randomized controlled trial on the implementation of a locally adapted guideline were used. The study involved 30 general practices and 1283 patients. Treatment targets differed between study groups [HbA1c <or= 8.0% and blood pressure (BP) < 140/85% versus HbA1c <or= 8.5% and BP < 150/85]. Clinical inertia was defined as the failure to intensify therapy when indicated. A complete medication profile of all participating patients was obtained.


RESULTS
In the intervention and control group, the percentages of patients with poor diabetes or lipid control who did not receive treatment intensification were 45% and 90%, approximately. More control group patients with BP levels above target were confronted with inertia (72.7% versus 63.3%, P < 0.05). In poorly controlled hypertensive patients, inertia was associated with the height of systolic BP at baseline [adjusted odds ratio (OR) 0.98, 95% confidence interval (CI) 0.98-0.99] and the frequency of BP control (adjusted OR 0.89, 95% CI 0.81-0.99). If a practice nurse managed these patients, clinical inertia was less common (adjusted OR 0.12, 95% CI 0.02-0.91). In both study groups, cholesterol decreased significantly more in patients who received proper treatment intensification.


CONCLUSIONS
GPs were more inclined to control blood glucose levels than BP or cholesterol levels. Inertia in response to poorly controlled high BP was less common if nurses assisted GPs.
van Bruggen
Rykel
R
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands. j.a.r.vanbruggen@umcutrecht.nl
Gorter
Kees
K
Stolk
Ronald
R
Klungel
Olaf
O
Rutten
Guy
G
D000368:Aged; D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'