Chronic Disease

Primary care practices face competing demands, not clinical inertia, in providing quality care to patients with diabetes

Primary care physicians often juggle the demands of several health conditions when treating patients with diabetes. They typically opt to treat the most pressing problem first, which may mean delaying a needed adjustment in diabetes medications until a subsequent appointment. Researchers have used the term "clinical inertia" to describe the situation in which primary care physicians recognize a problem but fail to act upon it.

University of Texas researcher Michael L. Parchman, M.D., M.P.H., concludes that conflicting demands, not inertia, are the real reason for the delay in treating increased blood sugar levels in patients with diabetes. In a study of 211 patients in 20 primary care clinics, Dr. Parchman and colleagues found that when multiple health issues were addressed during an appointment, such as elevated blood sugar levels, the most pressing health issue took precedence.

As a result, the physician was unlikely to adjust the patient's diabetes medication. However, the physician was likely to request that the patient return soon for a followup visit to address the blood sugar levels. Conversely, physicians were inclined to adjust medications for patients with elevated blood sugar levels who discussed only a few health complaints during an appointment.

These results indicate that physicians and patients prioritize demands and deal with the most serious first. The researchers suggest that studies using a model based on clinical inertia principles (favored by diabetes specialists) will likely produce misleading results and ineffective solutions. Primary care encounters are filled with multiple activities and require a balancing act of priorities and goal settings for the physician and the patient.

This study was funded in part by the Agency for Healthcare Research and Quality (HS13008).

See "Competing demands or clinical inertia: The case of elevated glycosylated hemoglobin," by Dr. Parchman, Jacqueline A. Pugh, M.D., Raquel L. Romero, M.D., and Krista W. Bowers, M.D., in the May/June 2007 Annals of Family Medicine 5(3), pp. 196-201.

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