Medical Affairs, Novo Nordisk Canada, Inc, Mississauga, Ontario, Canada.
Medical Affairs, Novo Nordisk Canada, Inc, Mississauga, Ontario, Canada.
Can J Diabetes. 2022 Mar;46(2):171-180. doi: 10.1016/j.jcjd.2021.08.004. Epub 2021 Aug 19.
Therapeutic inertia in type 2 diabetes (T2DM) is the failure to receive timely treatment intensification as indicated according to T2DM treatment guidelines. Multifactorial causes of therapeutic inertia in T2DM have been documented at the level of persons with diabetes (PwD), health-care providers and health-care systems.
We developed a 3-part mixed-methods research program, called the Moving to Overcome Therapeutic Inertia Obstacles Now in T2DM (MOTION) study, to inform the development of strategies to address therapeutic inertia in T2DM. We present the results from focus groups with the following objectives: 1) understanding PwD and general practitioner/family practitioner (GPFP) determinants of behaviour related to treatment intensification using the Theoretical Domains Framework (TDF); and 2) identifying the sources of behaviours contributing to therapeutic inertia in T2DM, as proposed by the Behaviour Change Wheel (BCW). Two focus groups with PwD and 4 with GPFPs were conducted. Transcripts from the focus groups were coded independently by 2 investigators to identify themes, then mapped to TDF domains and linked using the BCW.
For PwD, the most commonly coded TDF domains were intentions, goals, knowledge, beliefs about consequences and social influences. For GPFPs, the most common domains were intentions, environmental context and resources and social/professional role and identity. The BCW identified that PwD interventions should include reflective motivation, psychological capability and social opportunity; GPFP interventions should include physical opportunity, social opportunity and reflective motivation.
Comprehensive strategies that target both PwD and GPFP barriers would encourage a more collaborative approach toward treatment intensification decisions and reducing therapeutic inertia.
2 型糖尿病（T2DM）治疗惰性是指未能根据 T2DM 治疗指南及时进行治疗强化。已经在糖尿病患者（PwD）、医疗保健提供者和医疗保健系统层面记录了 T2DM 治疗惰性的多因素原因。
我们开发了一个三部分混合方法研究计划，称为“现在采取行动克服 T2DM 治疗惰性障碍”（MOTION）研究，以提供信息来制定解决 T2DM 治疗惰性的策略。我们展示了焦点小组的结果，目的如下：1）使用理论领域框架（TDF）了解与治疗强化相关的 PwD 和全科医生/家庭医生（GPFP）行为决定因素；2）根据行为改变车轮（BCW）确定导致 T2DM 治疗惰性的行为来源。对 PwD 和 GPFPs 进行了 2 次和 4 次焦点小组讨论。由 2 名调查员独立对焦点小组的记录进行编码，以确定主题，然后将其映射到 TDF 领域，并使用 BCW 进行链接。
对于 PwD，最常见的编码 TDF 领域是意图、目标、知识、对后果的信念和社会影响。对于 GPFPs，最常见的领域是意图、环境背景和资源以及社会/专业角色和身份。BCW 确定 PwD 干预措施应包括反思动机、心理能力和社会机会；GPFP 干预措施应包括物理机会、社会机会和反思动机。
针对 PwD 和 GPFPs 障碍的综合策略将鼓励更具协作性的方法来做出治疗强化决策并减少治疗惰性。
