Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands.
Fam Pract. 2009 Dec;26(6):428-36. doi: 10.1093/fampra/cmp053. Epub 2009 Sep 3.
Clinical inertia is considered a major barrier to better care. We assessed its prevalence, predictors and associations with the intermediate outcomes of diabetes care.
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.
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.
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.
临床惰性被认为是改善医疗的主要障碍。我们评估了其普遍性、预测因素及其与糖尿病治疗中间结果的关系。
使用荷兰一项关于实施本地化指南的随机对照试验的基线和随访数据。该研究涉及 30 家普通诊所和 1283 名患者。研究组的治疗目标不同[糖化血红蛋白（HbA1c）<8.0%且血压（BP）<140/85%与 HbA1c<8.5%且 BP<150/85%]。临床惰性被定义为在需要时未能加强治疗。所有参与患者的完整药物概况均已获得。
在干预组和对照组中，未接受治疗强化的糖尿病或血脂控制不佳的患者比例分别为 45%和 90%左右。更多的对照组患者血压水平高于目标，面临惰性（72.7%比 63.3%，P<0.05）。在控制不佳的高血压患者中，惰性与基线时收缩压的高度相关[调整后的优势比（OR）0.98，95%置信区间（CI）0.98-0.99]和血压控制的频率（调整后的 OR 0.89，95%CI 0.81-0.99）。如果执业护士管理这些患者，临床惰性则不太常见（调整后的 OR 0.12，95%CI 0.02-0.91）。在两个研究组中，接受适当治疗强化的患者胆固醇水平显著降低。
全科医生更倾向于控制血糖水平，而不是血压或胆固醇水平。如果护士协助全科医生，对控制不佳的高血压的惰性则较少。
