Clinical Inertia in Type2 Diabetic Patients in Community Hospitals in Ubon Ratchathani

Abstract

Objectives: To measure time from treatment initiation to clinical inertia in patients with type2 diabetes treated with oral antidiabetic agents identified by comparing with the Clinical Practice Guideline of Diabetes and to identify factors associated with clinical inertia.  Methods: This retrospective cohort study used electronic medical records of newly diagnosed type 2 diabetes patients who received medical services in 16 community hospitals in Ubon Ratchathani from June 1, 2008 through December 31, 2015.  The primary data were fasting blood sugar and types of oral antidiabetic agents received on the day of hospital visits, which were examined to identify diabetic patients with clinical inertia. Those with clinical inertia were the patients receiving no treatment intensification when the treatment goal was not achieved according to Clinical Practice Guidelines for Diabetes in 2008, 2011 and 2014, Identification of factors associated with clinical inertia was conducted using logistic regression analysis. Results: Of 15,228 eligible patients, 5,903 (38.76%) patients had clinical inertia.  The average time to first clinical inertia in patients receiving medical services during June 1, 2008 through December 31, 2010 (phase 1), January 1, 2011 through December 31, 2013 (phase 2) and January 1, 2014 through December 31, 2015 (phase 3) were 377.7 ± 5.46, 348.75 ± 3.39 and 316.75 ± 3.62 days respectively.  The proportion of patients with at least one clinical inertia was 19.35%, 32.61% and 42.73% in phase 1 to phase 3 respectively.  Statistically significant factors associated with lower clinical inertia were patients aged 55 – 62 years (OR = 0.75; 95%CI = 0.60 –0.94), and aged≥63 years (OR = 0.67; 95%CI = 0.54 – 0.83), being female (OR = 0.84; 95%CI = 0.73 – 0.98), patients with hypertension (OR = 0.85; 95%CI = 0.59 – 0.81), patients receiving medical service at two hospitals (OR = 0.14; 95%CI = 0.04 – 0.50, OR = 0.52; 95%CI = 0.35 – 0.79).  Conclusion: Clinical inertia was observed more frequently and with shorter time from phase 1 to phase 3.  Approximately one third of type 2 diabetic patients had clinical inertia.  Patients with older age, being female, having hypertension, and receiving care from 2 community hospitals were less likely to have clinical inertia than the others.