CLINICAL INERTIA
Help Your Doctor Take Better Care of You
Clinical inertia is the failure of health care providers to
initiate or intensify therapy when indicated. In the
diabetes field, the term refers to when it takes too long for a
health care professional to take action to improve glucose
control in a patient who is not at goal. The results of a
study conducted a few years ago demonstrated that it took
up to one to two years to either change or add a diabetes
medication once the A1c value was documented to be
above 8%. The study initiated much discussion about who
was to blame for this clinical inertia without too much
thought on how to fix this pervasive problem.
I believe that there are many
factors that contribute to clinical
inertia. First of all, physicians and
other caregivers often make changes
too slowly. The classic example is
resistance to starting insulin therapy
in a person with type 2 diabetes who
is doing poorly on oral medications.
Frequently, the patient is blamed for
not wanting to be "on the needle",
but research has shown that many
physicians are, in fact, not comfortable
with prescribing insulin. Let's
face it; people take the course of
least resistance and health care
professionals are people. This is
especially true if a caregiver has to
fill out prior authorization forms for
new medications that are restricted
in the patient's health care plan.
Obstacles or hassles involved in
prescribing the best medications or
devices for a patient are the perfect
fuel for perpetuating clinical inertia.
In addition to the health care
providers, people with diabetes also
contribute to clinical inertia. Many
of you reading this article probably
can relate to a question I commonly
hear from my
patients. "Do I really
need another
medication?" "Will I need to
be on this pill
for the rest of
my life?"
People natural
want to be on as few medications as
possible and this frame of reference
often limits proper and timely
diabetes care. I can certainly
empathize as I am on a handful of
medications in addition to my
insulin pump and continuous
glucose monitor.
Lastly, the limitations of the
current health care systems and
reduced health care dollars
contribute to clinical inertia.
Sometimes, we get the run around
attempting to obtain new drugs and
devices because of red tape and
bureaucracy. Getting a call back
from our caregivers or a timely
appointment is often times very
difficult. Even getting a copy of
our own lab results in many cases
is a struggle.
What can be done to limit or
eliminate clinical inertia? The
most important thing you can do
is to have and be knowledgeable
about your goals for control, always
get a copy of
your lab results
and understand
what they mean.
Then take action
to correct any
problems. For
example, if your
A1c is creeping
upward above your goal, make an
appointment or call your caregiver
to discuss the possible causes and
solutions. Don't wait until your next appointment if it is too far down
the road. If your LDL cholesterol is
above 100 mg/dl and this problem is
not currently being addressed, then
you need to speak to your caregiver
about getting to goal (less than 100
mg/dl). If you are not on aspirin,
find out why.
Assist or request assistance
from your caregiver when
appealing any health care claims for
new drugs and devices. You and
your health care provider are on the
same team, but there is no question
that you need to be the most active
member of your health care team.
Help your doctor take better care of
you.
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