Man F Y, Chen C Xr, Lau Y Y, Chan K
Department of Family Medicine & General Outpatient Clinic, Queen Elizabeth Hospital, Kowloon Central Cluster, Jordan, Hong Kong.
Hong Kong Med J. 2016 Aug;22(4):356-64. doi: 10.12809/hkmj154667. Epub 2016 Jun 17.
To study the prevalence of therapeutic inertia in lipid management among type 2 diabetic patients in the primary care setting and to explore associated factors.
This was a cross-sectional study involving type 2 diabetic patients with suboptimal lipid control followed up in all general out-patient clinics of Kowloon Central Cluster in Hong Kong from 1 October 2011 to 30 September 2013. Main outcome measures included prevalence of therapeutic inertia in low-density lipoprotein management among type 2 diabetic patients and its association with patient and physician characteristics.
Based on an agreed standard, lipid control was suboptimal in 49.1% (n=9647) of type 2 diabetic patients who attended for a regular annual check-up (n=19 662). Among the sampled 369 type 2 diabetic patients with suboptimal lipid control, therapeutic inertia was found to be present in 244 cases, with a prevalence rate of 66.1%. When the attending doctors' profiles were compared, the mean duration of clinical practice was significantly longer in the therapeutic inertia group than the non-therapeutic inertia group. Doctors without prior training in family medicine were also found to have a higher rate of therapeutic inertia. Patients in the therapeutic inertia group had longer disease duration, a higher co-morbidity rate of cardiovascular disease, and a closer-to-normal low-density lipoprotein level. Logistic regression analysis revealed that lack of family medicine training among doctors was positively associated with the presence of therapeutic inertia whereas patient's low-density lipoprotein level was inversely associated.
Therapeutic inertia was common in the lipid management of patients with type 2 diabetes in a primary care setting. Lack of family medicine training among doctors and patient's low-density lipoprotein level were associated with the presence of therapeutic inertia. Further study of the barriers and strategies to overcome therapeutic inertia is needed to improve patient outcome in this aspect of chronic disease management.
研究基层医疗环境中2型糖尿病患者血脂管理中治疗惰性的患病率，并探讨相关因素。
这是一项横断面研究，纳入了2011年10月1日至2013年9月30日在香港九龙中联网所有普通门诊诊所接受随访的血脂控制欠佳的2型糖尿病患者。主要结局指标包括2型糖尿病患者低密度脂蛋白管理中治疗惰性的患病率及其与患者和医生特征的关联。
根据商定标准，在参加年度定期检查的2型糖尿病患者（n = 19662）中，49.1%（n = 9647）的患者血脂控制欠佳。在抽样的369例血脂控制欠佳的2型糖尿病患者中，发现244例存在治疗惰性，患病率为66.1%。比较主治医生的资料时，治疗惰性组的临床实践平均时长显著长于非治疗惰性组。还发现未接受过家庭医学预先培训的医生治疗惰性率更高。治疗惰性组的患者病程更长，心血管疾病合并症发生率更高，低密度脂蛋白水平更接近正常。逻辑回归分析显示，医生缺乏家庭医学培训与治疗惰性的存在呈正相关，而患者的低密度脂蛋白水平与之呈负相关。
在基层医疗环境中，2型糖尿病患者血脂管理中治疗惰性很常见。医生缺乏家庭医学培训以及患者的低密度脂蛋白水平与治疗惰性的存在有关。需要进一步研究克服治疗惰性的障碍和策略，以改善慢性病管理这方面的患者结局。
