[Measuring intensification of therapy: a new indicator for quality of chronic care]

Abstract

Research in primary care showed that providers did not routinely respond to abnormal values of haemoglobin A1c, blood pressure or LDL cholesterol in patients with type 2 diabetes mellitus as defined in clinical practice guidelines. This problem is characterised as 'therapeutic inertia'. Providers may be reluctant to achieve the goals of therapy for several reasons. Firstly, target values have been lowered over time, partly due to influences from the pharmaceutical industry. Secondly, the applicability of clinical trial results to patients seen in primary care settings is limited. Thirdly, some patients prefer improvement of life style above drug therapy. Indicators for therapy intensification could be valid and useful for quality improvement if common reasons for non-adherence to guidelines are registered in electronic health records.