Clinical inertia among health care providers in a public health safety-net clinic in the management of type 2 diabetes

Abstract

BackgroundClinical inertia is defined as the lack of treatment intensification in patients who are not at evidence-based goals of therapy; it may be related to provider, patient, and health system–wide factors. Patient factors, including nonadherence and tablet burden, are further compounded by health and social disparities present in safety-net clinics. Clinical pharmacist–based interventions may impact provider or health system factors to reduce inertia in patients with poorly controlled diabetes. ObjectivesTo evaluate the rate of clinical inertia between health care providers in a safety-net clinic. MethodsA single-center, cross-sectional, retrospective study compared 2 cohorts of adult patients with type 2 diabetes and glycosylated hemoglobin (A1C) greater than 8% in 2016. Diabetes care was provided by clinical pharmacists in the intervention group and by primary care providers in the control group. The primary outcome was the difference in clinical inertia, measured by pharmacologic treatment intensification between groups within 4 months following the first A1C greater than 8% of the study period. ResultsOf 276 eligible patients, 72 were in the intervention group and 204 in the control group. There was no statistical difference between baseline A1C between groups, with an average A1C of 10.01% for the study population. In the pharmacist group versus provider group, the rate of overall treatment, noninsulin, and insulin intensification was 79% versus 49% (P < 0.001), 40% versus 32% (P = 0.19), and 54% versus 19% (P < 0.001), respectively. Patients were contacted an average of 4 times during the follow-up period in the pharmacist group as compared to 1 time in the provider group (P < 0.001). ConclusionIn this safety-net clinic, pharmacist-based interventions reduced clinical inertia in patients with poorly controlled diabetes. Future studies evaluating inertia long term and the impact on glycemic goals are needed.