News Article
Fight Inertia in Diabetes Care With Performance Feedback
WASHINGTON (EGMN) - Physicians and other health care providers who take care of diabetes patients can easily suffer from "clinical inertia," but performance feedback might help improve their performance, according to one diabetes expert.
Clinical inertia is defined as "failure to institute or change therapy appropriately when more intensive management is indicated," Catherine Barnes, Ph.D, said at the annual meeting of the American Association of Diabetes Educators.
This problem is usually not caused by unfamiliarity with practice guidelines or inadequate time for care, she noted. Instead, it usually occurs when providers use "soft" reasons to avoid intensifying therapy. For example, they tell the patient to "try the diet a little longer," or they say that a particular study's results don't apply to their own patients. Such providers also usually don't have systems to encourage them to step up therapy, such as flow sheets or "stepped" care protocols, said Dr. Barnes, who is with the Grady Diabetes Clinic in Atlanta.
Here's one scenario that commonly occurs at her clinic. A man comes in who is 57 years old and 5'8" tall, and weighs 210 pounds. His blood glucose is 200, hemoglobin A
"The patient insists he can lose weight, exercise, and limit his fats and salts," said Dr. Barnes. But when he returns, he's still doing what he did before, and his values are still abnormal, so he is prescribed glyburide, lisinopril, and simvastatin. One year later, his HbA
Why haven't the goals been reached?
Both patients and providers are trained not to be really aggressive with diabetes therapy, she said. "Patients don't change their diet because they're used to high-fat [food], or because they say they can't afford sugar-free items," said Dr. Barnes. "Socially, they complain about lack of family support, or lack of time - they're too busy to get the right food. Or they have trouble looking at food labels and at food exchanges."
On the caregiver side, one likely cause of inertia is that the providers have no way of knowing how their patients are doing as a group. So the clinic conducted a study to see whether giving feedback to providers would result in lower HbA
The patients had a mean age of 61; 64% were female, and 94% were black. The mean body mass index was 33.9, average diabetes duration was 12 years, and average HbA
The first year of the study served as a comparison period; no feedback was given. By the end of the first year, the patients' average HbA
Starting in the second year, the nurses had 5-minute feedback sessions with a diabetes specialist every 3 weeks. The specialists told the nurses how their particular patients were doing as a group in terms of HbA
At the end of the 2 years, the average HbA
In addition to receiving feedback, physicians and other providers can take several steps to improve their care of diabetes patients, according to Dr. Barnes. "One thing you can do is [post] reminders of high values," she said. "You can also give those numbers to patients, so the patient can become empowered to say, ‘My A
Chart reviews and ongoing flow sheets also can help, she said.
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