title: Impact of clinical inertia on cardiovascular risk factors in patients with diabetes.
abstract: OBJECTIVE
  To determine whether clinical inertia is associated with simpler interventions occurring more often than complex changes and the association between clinical inertia and outcomes.
  
  
  METHODS
  Prevalence of clinical inertia over a 30 month period for hyperglycaemia, hypertension and dyslipidaemia was calculated in a random sample (n=334) of patients attending a diabetes clinic. Comparisons between prevalence of clinical inertia and outcomes for each condition were examined using parametric tests of association.
  
  
  RESULTS
  There was less clinical inertia in hyperglycaemia (29% of consultations) compared with LDL (80% of consultations) and systolic BP (68% of consultations). Consultations where therapy was intensified had a greater reduction in risk factor levels than when no change was made. No association was found between treatment intensity scores and changes in HbA1c, LDL or blood pressure over 30 months.
  
  
  CONCLUSIONS
  Physicians are no more likely to intervene in conditions where simple therapeutic changes are necessary as opposed to complex changes. Greater clinical inertia leads to poorer outcomes. There continues to be substantial clinical inertia in routine clinical practice. Physicians should adopt a holistic approach to cardiovascular risk reduction in patients with diabetes, adhere more closely to established management guidelines and emphasize personal individualized target setting.
authors.affiliation: Department of Family Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, P.O. Box 15503, Adliya, Bahrain. Electronic address: dwhitford@rcsi-mub.com.
authors.forename: David L
authors.initials: DL
authors.lastname: Whitford
authors.affiliation: Department of Family Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, P.O. Box 15503, Adliya, Bahrain.
authors.forename: Hussam A
authors.initials: HA
authors.lastname: Al-Anjawi
authors.affiliation: Department of Family Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, P.O. Box 15503, Adliya, Bahrain.
authors.forename: Marwa M
authors.initials: MM
authors.lastname: Al-Baharna
mesh_terms: D001445:Bahrain / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D050171:Dyslipidemias / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D012017:Referral and Consultation / Q000639:trends; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Clinical inertia; Diabetes mellitus; Hyperlipidaemia; Hypertension