2394-PUB: Addressing Diabetes Therapy Inertia during Acute Care Transition

Abstract

Transition into inpatient care represents a moment of increased metabolic vulnerability for patients with diabetes. There is scant information on diabetes therapeutic inertia during patient acute care transition. We examined the prevalence of therapeutic inertia among internal medicine (IM) residents admitting adults with diabetes on insulin to the hospital, and hypothesized that lack of change in insulin prescribing behavior was associated with decreased knowledge and perceived self-efficacy and that it could be modified by a provider-based multimodal diabetes education intervention (PB-DM-EDI). Methods: IM inpatient residents were surveyed on perceived self-efficacy and evaluated on insulin therapy knowledge. A PB-DM-EDI including group sessions and on-site one-to-one patient-based teaching addressing knowledge, skills and electronic diabetes order sets and tools (DMOST) use was implemented over 4-months. Insulin regimens were reviewed during a 3-month period prior to and after PB-DM-EDI to screen for therapeutic inertia on admission, defined by the lack of change of pre-admission insulin orders. Results: We analyzed 51 surveys and 325 patient insulin regimens; 28 surveys and 148 patients prior to PB-DM-EDI and 23 surveys and 177 patients post PB-DM-EDI. Therapeutic inertia was identified in 49.3% and 35.6% of patients before and after PB-DM-EDI, respectively. Surveys revealed low self-efficacy and knowledge relating to insulin therapy; frequent DMOST use was only reported by 50% of residents. PB-DM-EDI increased perceived self-efficacy by 20%, basic knowledge by 5-18%; and self-reported frequent use of DMOST by 15%. Conclusion: Therapeutic inertia is high among providers caring for patients with diabetes transitioning to the acute care setting and is associated with decreased knowledge and self-efficacy with insulin management. Education interventions that incorporate EMR DMOST may decrease therapeutic inertia, but need to be combined with other strategies to increase their effectiveness. Disclosure A. Brown: None. L. Belalcazar: None.