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Pharm Pract (Granada). 2013 Oct;11(4):203-10. Epub 2013 Dec 20.

Clinical inertia in type 2 diabetes: A retrospective analysis of pharmacist-managed diabetes care vs. usual medical care.

Author information

1
UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California , San Diego. La Jolla, CA ( United States ). fyam@ucsd.edu.
2
College of Pharmacy, University of Kentucky . Lexington, KY ( United States ). argelh1@email.uky.edu.
3
College of Pharmacy, University of Kentucky . Lexington, KY ( United States ). hsdivi1@email.uky.edu.
4
Manchester Pharmacy School, University of Manchester . Manchester ( United Kingdom ). douglas.steinke@manchester.ac.uk.
5
College of Pharmacy, University of Kentucky . Lexington, KY ( United States ). mjone5@email.uky.edu.

Abstract

BACKGROUND:

Evidence suggests that patients with type 2 diabetes (T2DM) suffer from a high rate of "clinical inertia" or "recognition of the problem but failure to act."

OBJECTIVE:

THE AIM OF THIS STUDY IS TO QUANTIFY THE RATE OF CLINICAL INERTIA BETWEEN TWO MODELS OF CARE: Pharmacist-Managed Diabetes Clinic (PMDC) vs. Usual Medical Care (UMC).

METHODS:

Patients in a university based medical clinic with type 2 diabetes (T2DM) were analyzed in this retrospective cohort study. Patients were exposed to either PMDC or UMC. The difference in days to intervention in response to suboptimal laboratory values and time to achieve goal hemoglobin A1c (A1c), systolic blood pressure (SBP) and low-density lipoprotein (LDL) was compared in the two models of care.

RESULTS:

A total of 113 patients were included in the analysis of this study, 54 patients were in the PMDC and 59 patients were in the UMC group. Median time (days) to intervention for A1c values >7% was 8 days and 9 days in the PMDC and UMC groups, respectively (p>0.05). In patients with baseline A1c values >8%, median time to achieving A1c<7% was 259 days vs. 403 days in the PMDC and UMC groups, respectively (p<0.05). Median time to goal SBP was 124 days in the PMDC group and 532 days in the UMC group (p<0.05). Median time to goal LDL was 412 days in the PMDC group vs. 506 days in the UMC group (p<0.05).

CONCLUSIONS:

Rates of clinical inertia, defined as time to intervention of suboptimal clinical values, did not differ significantly between patients enrolled in a PMDC compared to patients with UMC with respect to A1c, SBP and LDL. Participation in PMDC, however, was associated with achieving goal A1c, SBP, and LDL levels sooner compared to UMC.

KEYWORDS:

Delivery of Health Care; Diabetes Mellitus, Type 2; Efficiency; Pharmaceutical Services; United States

PMID:
24367460
PMCID:
PMC3869636
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