Predictors of Clinical Inertia and Type 2 Diabetes: Assessment of Primary Care Physicians and Their Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Ethical Approval
2.2. Population, Sample Size and Procedures
2.3. Research Instruments
2.4. Statistical Analysis
3. Results
3.1. Patients’ Profiles and Clinical Inertia—Health Conditions and Behavior
3.2. Phenomenon of Clinical Inertia in Type 2 Diabetes Treatment
3.3. Predictors of Clinical Inertia—Multivariate Logistic Model
4. Discussion
4.1. Challenges of Clinical Inertia in the Treatment of Type 2 Diabetes
4.2. Patients’ Health Condition, Behavior and Clinical Inertia
4.3. Current Treatment and the Clinical Inertia
4.4. Healthcare System Descriptors and Clinical Inertia
4.5. Strengths and Limitations of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Total (n = 543) | Clinical Inertia (n = 224) | Without Clinical Inertia (n = 319) | p-Value |
---|---|---|---|---|
Gender, n (%) | 0.370 | |||
Female Male | 268 (49.7%) 271 (50.3%) | 116 (52.0%) 107 (48.0%) | 152 (48.1%) 164 (51.9%) | |
Age, Median (range) | 67 (31–86) | 67 (31–85) | 67 (31–86) | 0.981 |
BMI, Mean (range) | 28.25 (16.4–45.0) | 28.77 (18.5–45.0) | 27.89 (16.4–45) | 0.024 |
Marital status, n (%) | 0.957 | |||
Married/living with partner Living alone Divorced Widower/widow | 354 (69.1) 50 (9.8%) 31 (31%) 77 (15%) | 150 (68.8%) 22 (10.1%) 12 (5.5%) 34 (15.6%) | 204 (69.4%) 28 (9.5%) 19 (6.5%) 43 (14.6%) | |
Working status, n (%) | 0.390 | |||
Temporary work Permanent work Unemployed Retired | 130 (25.3%) 23 (4.5%) 34 (6.6%) 326 (63.5%) | 52 (23.7%) 12 (5.5%) 11 (5.0%) 144 (65.8%) | 78 (26.5%) 11 (3.7%) 23 (7.8%) 182 (61.9%) | |
Educational level, n (%) | 0.067 | |||
Elementary school High/Secondary school College Faculty | 52 (10.3%) 277 (54.6%) 86 (17.0%) 92 (18.1%) | 23 (10.6%) 128 (59.0%) 35 (16.1%) 31 (14.3%) | 29 (10.0%) 149 (51.4%) 51 (17.6%) 61 (21%) | |
Patients’ estimation of monthly income, n (%) | 0.877 | |||
Very low Low Average Good Very good | 16 (3.1%) 72 (14.1%) 263 (51.7%) 125 (24.6%) 33 (6.5%) | 7 (3.3%) 26 (12.1%) 118 (54.9%) 55 (25.6%) 9 (4.2%) | 9 (3.1%) 46 (15.6%) 145 (49.3%) 70 (23.8%) 24 (8.2%) | |
Overall health condition (physicians’ estimation), n (%) | 0.007 | |||
Very poor Poor Average Good Very good | 3 (0.6%) 80 (14.8%) 277 (51.4%) 169 (31.4%) 10 (1.9%) | 2 (0.9%) 42 (19.1%) 114 (51.8%) 56 (26.8%) 3 (1.4%) | 1 (0.3%) 38 (11.9%) 163 (51.1%) 110 (34.5%) 7 (2.2%) | |
Diabetes duration, Median (Range) | 10 (1–46) | 12 (1–46) | 10 (1–40) | <0.001 |
Presence of comorbidities, n (%) | 0.001 | |||
No Yes | 170 (31.4%) 372 (68.6%) | 52 (23.2%) 172 (76.8%) | 118 (37.1%) 200 (62.9%) |
Variables | Total (n = 543) | Clinical Inertia (n = 224) | Without Clinical Inertia (n = 319) | p-Value |
---|---|---|---|---|
Overall health condition (patients’ estimation), n (%) | <0.001 | |||
Very poor Poor Average Good Very good | 4 (0.8%) 68 (12.8%) 266 (50.1%) 169 (31.8%) 24 (4.5%) | 4 (1.8%) 39 (17.8%) 112 (51.1%) 57 (26.0%) 7 (3.2%) | 0 (0.0%) 29 (9.3%) 154 (49.4%) 112 (35.9%) 17 (5.4%) | |
Type of physical activity, n (%) | 0.101 | |||
Without Mild Moderate Intense | 44 (8.2%) 388 (72.3%) 53 (9.9%) 52 (9.7%) | 19 (8.6%) 167 (75.6%) 19 (8.6%) 16 (7.2%) | 25 (7.9%) 221 (69.9%) 34 (10.8%) 36 (11.4%) | |
Diet adjustments according to physician suggestions, n (%) | 0.006 | |||
I am not following it As possible Fully | 40 (7.6%) 389 (73.7%) 99 (18.8%) | 18 (8.4%) 170 (79.4%) 26 (12.1%) | 22 (7.0%) 219 (69.7%) 73 (23.2%) | |
Fruit consumption, n (%) | 0.001 | |||
Never Less than once monthly 1–3 times per week 4–6 times per week Once daily Two or more times per day | 4 (0.7%) 32 (6.0%) 108 (20.2%) 98 (18.3%) 214 (40.0%) 79 (14.8%) | 1 (0.5%) 15 (6.8%) 59 (26.8%) 43 (19.5%) 78 (35.5%) 24 (10.9%) | 3 (1.0%) 17 (5.4%) 49 (15.6%) 55 (17.5%) 136 (43.2%) 55 (17.5%) | |
Vegetable consumption, n (%) | 0.005 | |||
Never Less than once monthly 1–3 times per week 4–6 times per week Once daily Two or more times per day | 1 (0.2%) 16 (3.0%) 72 (13.5%) 93 (17.4%) 204 (38.1%) 149 (27.9%) | 1 (0.5%) 8 (3.6%) 35 (15.9%) 41 (18.6%) 88 (40.0%) 47 (21.4%) | 0 (0.0%) 8 (2.5%) 37 (11.7%) 52 (16.5%) 116 (36.8%) 102 (32.4%) | |
Smoking status, n (%) | 0.600 | |||
Yes, regularly Yes, from time to time No | 82 (15.5%) 43 (8.1%) 403 (76.3%) | 30 (13.7%) 19 (8.7%) 170 (77.6%) | 52 (16.8%) 24 (7.8%) 233 (75.4%) | |
More than 6 alcoholic drinks in last 12 months, n (%) | 0.700 | |||
Never Once per month Once per week Every day or almost every day | 401 (76.4%) 87 (16.6%) 33 (6.3%) 4 (0.8%) | 166 (75.6%) 35 (16.0%) 15 (6.8%) 3 (1.4%) | 235 (76.8%) 52 (17.0%) 18 (5.9%) 1 (0.3%) |
Variables | Total (n = 543) | Clinical Inertia (n = 224) | Without Clinical Inertia (n = 319) | p-Value |
---|---|---|---|---|
Current treatment: Exercise and diet, n (%) No Yes | 0.556 | |||
218 (40.2%) 324 (59.8%) | 93 (41.7%) 130 (58.3%) | 125 (39.2%) 194 (60.8%) | ||
Current treatment: Metformin, n (%) No Yes | 0.369 | |||
95 (17.5%) 447 (82.5%) | 43 (19.3%) 180 (80.7%) | 52 (16.3%) 267 (83.7%) | ||
Current treatment: Sulfonylureas, n (%) No Yes | 0.026 | |||
357 (65.9%) 185 (34.1%) | 159 (71.3%) 64 (28.7%) | 198 (62.1%) 121 (37.9%) | ||
Current treatment: DPP-4 inhibitors, n (%) No Yes | 0.694 | |||
536 (98.9%) 6 (1.1%) | 220 (98.7%) 3 (1.3%) | 316 (99.1%) 3 (0.9%) | ||
Current treatment: SGLT-2 inhibitors, n (%) No Yes | 0.086 | |||
499 (92.1%) 43 (7.9%) | 200 (89.7%) 23 (10.3%) | 299 (93.7%) 20 (6.3%) | ||
Current treatment: GLP-1 RA, n (%) No Yes | 0.411 | |||
541 (99.8%) 1 (0.2%) | 222 (99.6%) 1 (0.4%) | 319 (100%) 0 (0.0%) | ||
Current treatment: Human insulin Short-acting, n (%) No Yes | 0.283 | |||
518 (95.7%) 23 (4.3%) | 216 (96.9%) 7 (3.1%) | 302 (95.0%) 16 (5.0%) | ||
Current treatment: Human insulin Basal, n (%) No Yes | 0.709 | |||
477 (88.2%) 64 (11.8%) | 198 (88.8%) 25 (11.2%) | 279 (87.7%) 39 (12.3%) | ||
Current treatment: Human insulin Biphasic, n (%) No Yes | 0.030 | |||
517 (95.6%) 24 (4.4%) | 208 (93.3%) 15 (6.7%) | 309 (97.2%) 9 (2.8%) | ||
Current treatment: Insulin analogue Short-acting, n (%) No Yes | <0.001 | |||
473 (87.4%) 68 (12.6%) | 174 (78.0%) 49 (22.0%) | 299 (94.0%) 19 (6.0%) | ||
Current treatment: Insulin analogue Basal, n (%) No Yes | <0.001 | |||
418 (77.3%) 123 (22.7%) | 145 (65.0%) 78 (35.0%) | 273 (85.8%) 45 (14.2%) | ||
Current treatment: Insulin analogue Biphasic, n (%) No Yes | 0.002 | |||
504 (93.2%) 37 (6.8%) | 199 (89.2%) 24 (10.8%) | 305 (95.9%) 13 (4.1%) | ||
Type of current treatment, n (%) | <0.001 | |||
Exersise and diet OAD OAD combinations (2–3) Basal insulin +/− OAD(s) Intensified insulin treatment +/− OAD(s) | 11 (2%) 132 (24.3%) 159 (29.3%) 139 (25.6%) 102 (18.8%) | 5 (2.2%) 29 (12.9%) 53 (23.7%) 77 (34.4%) 60 (26.8%) | 6 (1.9%) 103 (32.3%) 106 (33.2%) 62 (19.4%) 42 (13.2%) |
Variables | Total (n = 543) | Clinical Inertia (n = 224) | Without Clinical Inertia (n = 319) | p-Value |
---|---|---|---|---|
Laboratory FPG result frequency, n (%) | 0.151 | |||
Never From time to time Regularly | 54 (10.2%) 326 (61.6%) 149 (28.2%) | 20 (9.3%) 145 (67.4%) 50 (23.3%) | 34 (10.8%) 181 (57.6%) 99 (31.5%) | |
FPG at current visit (mmol/L), Mean (Range) | 7.92 (2.6–27.6) | 8.65 (3.80–27.60) | 7.43 (2.6–17.00) | |
Laboratory HbA1c result frequency, n (%) | 0.003 | |||
Never From time to time Regularly | 29 (5.9%) 354 (72.2%) 107 (21.8%) | 15 (7.7%) 151 (77.0%) 30 (15.3%) | 14 (4.8%) 203 (69.0%) 77 (26.2%) | |
HbA1c at current visit (%), Mean (Range) | 7.32 (5.03–14) | 8.02 (7.07–17.00) | 6.83 (5.03–11.35) | |
Providing glycemia profile at the visit, n (%) | 0.450 | |||
Never From time to time Regularly | 170 (31.7%) 314 (58.5%) 53 (9.9%) | 61 (27.9%) 141 (64.4%) 17 (7.8%) | 109 (34.3%) 173 (54.4%) 36 (9.9%) | |
Is glycemia profile complete, n (%) | 0.179 | |||
No Sometimes Yes | 168 (35.1%) 108 (22.5%) 203 (42.4%) | 79 (38.7%) 44 (21.6%) 81 (39.7%) | 89 (32.4%) 64 (23.3%) 122 (44.4%) | |
Providing lipid values at the visit, n (%) | 0.001 | |||
Never From time to time Regularly | 15 (2.8%) 404 (75.4%) 117 (21.8) | 8 (3.7%) 178 (81.7%) 32 (14.7%) | 7 (2.2%) 226 (71.1%) 85 (26.7%) | |
Patient is reporting hypoglycemia, n (%) | 0.005 | |||
No Yes | 413 (78.2%) 115 (21.8%) | 159 (72.3%) 61 (27.7%) | 254 (82.5%) 54 (17.5%) |
Variables | Total (n = 543) | Clinical Inertia (n = 224) | Without Clinical Inertia (n = 319) | p-Value |
---|---|---|---|---|
Average duration of examination, Median (Range) | 15 (5–45) | 15 (5–45) | 15 (5–40) | 0.524 |
Agreed goal of treatment, n (%) | 0.365 | |||
No Yes | 24 (4.6%) 499 (95.4%) | 12 (5.6%) 203 (94.4%) | 12 (3.9%) 296 (96.1%) | |
Predefined visit plan, n (%) | 0.854 | |||
No Yes | 92 (17.7%) 429 (82.3%) | 37 (17.3%) 177 (82.7%) | 55 (17.9%) 252 (82.1%) | |
Presence of counseling unit, n (%) | 0.597 | |||
No Yes | 294 (56.0%) 231 (44.0%) | 118 (54.6%) 98 (45.4%) | 176 (57.0%) 133 (43.0%) | |
Existence patient registry, n (%) | 0.926 | |||
No Yes | 54 (10.5%) 459 (89.5%) | 22 (10.4%) 190 (89.6%) | 32 (10.6%) 269 (89.4%) | |
Special Medical record (counseling unit/preventive center), n (%) | 0.387 | |||
No Yes | 180 (35.3%) 330 (64.7%) | 78 (37.5%) 130 (62.5%) | 102 (33.8%) 200 (66.2%) | |
For further treatment adjustment patients are referred to specialist unit at primary health center, n (%) | 0.956 | |||
No Yes | 346 (67.4%) 167 (32.6%) | 140 (67.3%) 68 (32.7%) | 206 (67.5%) 99 (32.5%) | |
For further treatment adjustment patients are referred to Clinical Hospital Center, n (%) | 0.019 | |||
No Yes | 319 (62.2%) 194 (37.8%) | 142 (68.3%) 66 (31.7%) | 177 (58.0%) 128 (42.0%) | |
For further treatment adjustment patients are referred to University Clinical Center of Serbia, n (%) | 0.453 | |||
No Yes | 328 (63.9%) 185 (36.1%) | 137 (65.9%) 71 (34.1%) | 191 (62.6%) 114 (37.4%) | |
For further treatment adjustment patients are referred to counseling units, n (%) | 0.685 | |||
No Yes | 345 (67.3%) 168 (32.7%) | 142 (68.3%) 66 (31.7%) | 203 (66.6%) 102 (33.4%) |
Variables | B | p | OR | 95% CI Lower | 95% CI Upper |
---|---|---|---|---|---|
BMI | 0.037 | 0.189 | 1.04 | 0.98 | 1.10 |
Diet adjustments according to physician suggestions | −0.734 | 0.003 | 0.5 | 0.3 | 0.8 |
Patient overall health condition, physicians’ estimation | −0.127 | 0.439 | 0.9 | 0.6 | 1.2 |
Number of comorbidities | 0.020 | 0.843 | 1.0 | 0.8 | 1.2 |
Diabetes duration | −0.006 | 0.767 | 0.99 | 0.96 | 1.03 |
Frequency of FPG measurement | 0.080 | 0.300 | 1.1 | 0.9 | 1.3 |
Laboratory HbA1c result frequency (never) | ref. | ||||
Laboratory HbA1c result frequency (occasionally) | −0.153 | 0.758 | 0.9 | 0.3 | 2.3 |
Laboratory HbA1c result frequency (regularly) | −1.164 | 0.047 | 0.3 | 0.1 | 1.0 |
Current treatment-Human insulin fixed mix | 1.020 | 0.085 | 2.8 | 0.9 | 8.9 |
Current treatment-Insulin analogue short-acting | 1.499 | 0.002 | 4.5 | 1.8 | 11.3 |
Current treatment-Insulin analogue basal | 0.960 | 0.011 | 2.6 | 1.2 | 5.5 |
Current treatment-Insulin analogue biphasic | 1.491 | 0.003 | 4.4 | 1.6 | 12.0 |
Last treatment change | 0.310 | <0.001 | 1.4 | 1.2 | 1.6 |
Last treatment change (dose change of the same medication) | ref. | ||||
Last treatment change (medication change) | −0.002 | 0.995 | 1.0 | 0.6 | 1.8 |
Last treatment change (adding additional drug on current treatment) | 0.643 | 0.019 | 1.9 | 1.1 | 3.3 |
Patient referral to Clinical Hospital Center | −0.560 | 0.023 | 0.6 | 0.4 | 0.9 |
Physician’s continuing education about diabetes | −0.037 | 0.907 | 1.0 | 0.5 | 1.8 |
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Isajev, N.; Bjegovic-Mikanovic, V.; Bukumiric, Z.; Vrhovac, D.; Lalic, N.M. Predictors of Clinical Inertia and Type 2 Diabetes: Assessment of Primary Care Physicians and Their Patients. Int. J. Environ. Res. Public Health 2022, 19, 4436. https://doi.org/10.3390/ijerph19084436
Isajev N, Bjegovic-Mikanovic V, Bukumiric Z, Vrhovac D, Lalic NM. Predictors of Clinical Inertia and Type 2 Diabetes: Assessment of Primary Care Physicians and Their Patients. International Journal of Environmental Research and Public Health. 2022; 19(8):4436. https://doi.org/10.3390/ijerph19084436
Chicago/Turabian StyleIsajev, Nemanja, Vesna Bjegovic-Mikanovic, Zoran Bukumiric, David Vrhovac, and Nebojsa M. Lalic. 2022. "Predictors of Clinical Inertia and Type 2 Diabetes: Assessment of Primary Care Physicians and Their Patients" International Journal of Environmental Research and Public Health 19, no. 8: 4436. https://doi.org/10.3390/ijerph19084436