Clinical inertia and its impact on treatment intensification in people with type 2 diabetes mellitus
| Autor: | Antonio Ceriello, Valeria Pechtner, Antonella Corcos, Gérard Reach, R. Gentilella |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Combination therapy Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Physicians Primary Care 03 medical and health sciences 0302 clinical medicine Endocrinology Quality of life (healthcare) Internal Medicine Humans Medicine 030212 general & internal medicine Practice Patterns Physicians' Medical prescription Intensive care medicine Therapeutic inertia Physician-Patient Relations business.industry Public health Type 2 Diabetes Mellitus General Medicine Decision Support Systems Clinical Treatment Outcome Diabetes Mellitus Type 2 Good clinical practice Quality of Life Physical therapy Morbidity business Specialization Patient education |
| Zdroj: | Diabetes & Metabolism. 43:501-511 |
| ISSN: | 1262-3636 |
| DOI: | 10.1016/j.diabet.2017.06.003 |
| Popis: | Many people with type 2 diabetes mellitus (T2DM) fail to achieve glycaemic control promptly after diagnosis and do not receive timely treatment intensification. This may be in part due to 'clinical inertia', defined as the failure of healthcare providers to initiate or intensify therapy when indicated. Physician-, patient- and healthcare-system-related factors all contribute to clinical inertia. However, decisions that appear to be clinical inertia may, in fact, be only 'apparent' clinical inertia and may reflect good clinical practice on behalf of the physician for a specific patient. Delay in treatment intensification can happen at all stages of treatment for people with T2DM, including prescription of lifestyle changes after diagnosis, introduction of pharmacological therapy, use of combination therapy where needed and initiation of insulin. Clinical inertia may contribute to people with T2DM living with suboptimal glycaemic control for many years, with dramatic consequences for the patient in terms of quality of life, morbidity and mortality, and for public health because of the huge costs associated with uncontrolled T2DM. Because multiple factors can lead to clinical inertia, potential solutions most likely require a combination of approaches involving fundamental changes in medical care. These could include the adoption of a person-centred model of care to account for the complex considerations influencing treatment decisions by patients and physicians. Better patient education about the progressive nature of T2DM and the risks inherent in long-term poor glycaemic control may also reinforce the need for regular treatment reviews, with intensification when required. |
| Databáze: | OpenAIRE |
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