Assessment of clinical inertia in people with diabetes within primary care.

Autor: Meredith AH; Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.; Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA., Buatois EM; Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.; Department of Pharmacy, Texas Tech University Health Sciences Center, 5220 80th Street, Lubbock, TX, 79424, USA., Krenz JR; Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.; Department of Pharmacy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Walroth T; Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA., Shenk M; Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA.; Department of Pharmacy Practice, Cedarville University School of Pharmacy, 251 N Main St, Cedarville, OH, 45341, USA., Triboletti JS; Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA.; Department of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave, Indianapolis, IN, 46208, USA., Pence L; Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA., Gonzalvo JD; Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.; Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA.
Jazyk: angličtina
Zdroj: Journal of evaluation in clinical practice [J Eval Clin Pract] 2021 Apr; Vol. 27 (2), pp. 365-370. Date of Electronic Publication: 2020 Jun 16.
DOI: 10.1111/jep.13429
Abstrakt: Rationale, Aims and Objectives: Clinical inertia, defined as a delay in treatment intensification, is prevalent in people with diabetes. Treatment intensification rates are as low as 37.1% in people with haemoglobin A1c (HbA1c) values >7%. Intensification by addition of medication therapy may take 1.6 to more than 7 years. Clinical inertia increases the risk of cardiovascular events. The primary objective was to evaluate rates of clinical inertia in people whose diabetes is managed by both pharmacists and primary care providers (PCPs). Secondary objectives included characterizing types of treatment intensification, HbA1c reduction, and time between treatment intensifications.
Method: Retrospective chart review of persons with diabetes managed by pharmacists at an academic, safety-net institution. Eligible subjects were referred to a pharmacist-managed cardiovascular risk reduction clinic while continuing to see their PCP between October 1, 2016 and June 30, 2018. All progress notes were evaluated for treatment intensification, HbA1c value, and type of medication intensification.
Results: Three hundred sixty-three eligible patients were identified; baseline HbA1c 9.6% (7.9, 11.6) (median interquartile range [IQR]). One thousand one hundred ninety-two pharmacist and 1739 PCP visits were included in data analysis. Therapy was intensified at 60.5% (n = 721) pharmacist visits and 39.3% (n = 684) PCP visits (P < .001). The median (IQR) time between interventions was 49 (28, 92) days for pharmacists and 105 (38, 182) days for PCPs (P < .001). Pharmacists more frequently intensified treatment with glucagon-like peptide-1 agonists and sodium glucose cotransporter-2 inhibitors.
Conclusion: Pharmacist involvement in diabetes management may reduce the clinical inertia patients may otherwise experience in the primary care setting.
(© 2020 John Wiley & Sons, Ltd.)
Databáze: MEDLINE
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