Bralić Lang Valerija, Bergman Marković Biserka, Kranjčević Ksenija
Private Family Physician Office affiliated to University of Zagreb, School of Medicine, Zagreb, Croatia.
Department of Family Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia.
Med Sci Monit. 2015 Feb 5;21:403-11. doi: 10.12659/MSM.892248.
Many patients with diabetes do not achieve target values. One of the reasons for this is clinical inertia. The correct explanation of clinical inertia requires a conjunction of patient with physician and health care system factors. Our aim was to determine the rate of clinical inertia in treating diabetes in primary care and association of patient, physician, and health care setting factors with clinical inertia.
This was a national, multicenter, observational, cross-sectional study in primary care in Croatia. Each family physician (FP) provided professional data and collected clinical data on 15-25 type 2 diabetes (T2DM) patients. Clinical inertia was defined as a consultation in which treatment change based on glycated hemoglobin (HbA1c) levels was indicated but did not occur.
A total of 449 FPs (response rate 89.8%) collected data on 10275 patients. Mean clinical inertia per FP was 55.6% (SD ±26.17) of consultations. All of the FPs were clinically inert with some patients, and 9% of the FPs were clinically inert with all patients. The main factors associated with clinical inertia were: higher percentage of HbA1c, oral anti-diabetic drug initiated by diabetologist, increased postprandial glycemia and total cholesterol, physical inactivity of patient, and administration of drugs other than oral antidiabetics.
Clinical inertia in treating patients with T2DM is a serious problem. Patients with worse glycemic control and those whose therapy was initiated by a diabetologist experience more clinical inertia. More research on causes of clinical inertia in treating patients with T2DM should be conducted to help achieve more effective diabetes control.
许多糖尿病患者未达到目标值。其中一个原因是临床惰性。对临床惰性的正确解释需要结合患者、医生和医疗保健系统因素。我们的目的是确定初级保健中治疗糖尿病的临床惰性发生率，以及患者、医生和医疗保健环境因素与临床惰性的关联。
这是一项在克罗地亚初级保健领域开展的全国性、多中心、观察性横断面研究。每位家庭医生（FP）提供专业数据，并收集15 - 25例2型糖尿病（T2DM）患者的临床数据。临床惰性定义为基于糖化血红蛋白（HbA1c）水平显示需要改变治疗但未发生改变的会诊。
共有449名家庭医生（回复率89.8%）收集了10275例患者的数据。每位家庭医生的平均临床惰性会诊率为55.6%（标准差±26.17）。所有家庭医生对部分患者存在临床惰性，9%的家庭医生对所有患者都存在临床惰性。与临床惰性相关的主要因素包括：HbA1c百分比更高、由糖尿病专家启动口服抗糖尿病药物、餐后血糖和总胆固醇升高、患者缺乏身体活动以及使用口服抗糖尿病药物以外的其他药物。
治疗T2DM患者时的临床惰性是一个严重问题。血糖控制较差以及治疗由糖尿病专家启动的患者经历的临床惰性更多。应针对治疗T2DM患者临床惰性的原因开展更多研究，以帮助实现更有效的糖尿病控制。
