Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
Clinical Research Unit, Hospital Pengajar Universiti Putra Malaysia (HPUPM Teaching Hospital), Persiaran MARDI-UPM, Malaysia.
Endocrinol Metab (Seoul). 2023 Feb;38(1):34-42. doi: 10.3803/EnM.2022.1649. Epub 2023 Feb 16.
The ultimate purpose of diabetes care is achieving the outcomes that patients regard as important throughout the life course. Despite advances in pharmaceuticals, nutraceuticals, psychoeducational programs, information technologies, and digital health, the levels of treatment target achievement in people with diabetes mellitus (DM) have remained suboptimal. This clinical care of people with DM is highly challenging, complex, costly, and confounded for patients, physicians, and healthcare systems. One key underlying problem is clinical inertia in general and therapeutic inertia (TI) in particular. TI refers to healthcare providers' failure to modify therapy appropriately when treatment goals are not met. TI therefore relates to the prescribing decisions made by healthcare professionals, such as doctors, nurses, and pharmacists. The known causes of TI include factors at the level of the physician (50%), patient (30%), and health system (20%). Although TI is often multifactorial, the literature suggests that 28% of strategies are targeted at multiple levels of causes, 38% at the patient level, 26% at the healthcare professional level, and only 8% at the healthcare system level. The most effective interventions against TI are shorter intervals until revisit appointments and empowering nurses, diabetes educators, and pharmacists to review treatments and modify prescriptions.
糖尿病护理的最终目的是实现患者在整个生命过程中认为重要的结果。尽管在药物、营养保健品、心理教育计划、信息技术和数字健康方面取得了进展，但糖尿病患者的治疗目标达标水平仍然不理想。这种对糖尿病患者的临床护理极具挑战性、复杂性、高成本，并且对患者、医生和医疗保健系统造成困扰。一个关键的潜在问题是普遍存在的临床惰性和治疗惰性（TI）。TI 是指当治疗目标未达到时，医疗保健提供者未能适当调整治疗。因此，TI 与医疗保健专业人员（如医生、护士和药剂师）做出的处方决策有关。TI 的已知原因包括医生层面的因素（50%）、患者层面的因素（30%）和医疗系统层面的因素（20%）。尽管 TI 通常是多因素的，但文献表明，28%的策略针对多个层面的原因，38%针对患者层面，26%针对医疗保健专业人员层面，只有 8%针对医疗保健系统层面。针对 TI 最有效的干预措施是缩短复诊预约的间隔时间，并赋予护士、糖尿病教育者和药剂师审查治疗和修改处方的权力。
