Improving Type 2 Diabetes Mellitus Related Clinical Inertia in Primary Care
Abstract
Background: Clinical inertia (CI) is a phenomenon where there is a delay of initiation or intensification of chronic disease management. Type 2 Diabetes Mellitus (T2DM) is primed for provider driven CI due to the rapid development and availability of diabetes-related medications, provider beliefs, and role ambiguity. These factors can overwhelm Primary Care Providers (PCPs) and lead to suboptimal diabetes management. An evidence-based solution to combat provider driven CI recommends a structured continuing education program focused on current American Diabetes Association (ADA) guidelines. PICO: In a primary care clinic, how does a diabetes mellitus (DM) education program and intensive diabetes care clinic (IDCC) optimization impact provider attitudes towards DM management, medication use, and IDCC utilization? Project Design: Pre/post education intervention for twelve family medicine PCPs consisted of seven weekly 20-minute sessions taught by a clinical pharmacist. Session topics covered current ADA guidelines, anti-diabetic medications, and IDCC referral criteria. The Diabetes Attitude Survey version 3 (DAS3) questionnaire was completed pre and post-intervention. PCP antidiabetic medication prescribing history and IDCC utilization was audited monthly, beginning three months prior through one month after intervention. Results: Medication use audit showed an increase in anti-diabetic medications prescribed during/post-intervention (p = .003). There was an increase in newer generation drug classes prescribed during/post-intervention (p =.009). DAS3 pre/post provider attitudes showed no overall statistical change. Providers under the age of 40 were more likely to perceive that patients should have autonomy in T2DM management (p =.043). IDCC showed no change in utilization. Implications for Practice: T2DM left uncontrolled may affect medical readiness by limiting service member assignability, deployability, and retention.
Document Details
- Document Type
- Technical Report
- Publication Date
- May 01, 2023
- Accession Number
- AD1212209
Entities
People
- Brennda A. Tsuhako
- Patrick A. Burns
Organizations
- Uniformed Services University of the Health Sciences