Overcoming Therapeutic Inertia as the Achilles' Heel for Improving Suboptimal Diabetes Care: An Integrative Review

Abstract

The ultimate purpose of diabetes care is achieving the outcomes that patients regard as important throughout the life course. Despite advances in pharmaceuticals, nutraceuticals, psychoeducational programs, information technologies, and digital health, the levels of treatment target achievement in people with diabetes mellitus (DM) have remained suboptimal. This clinical care of people with DM is highly challenging, complex, costly, and confounded for patients, physicians, and healthcare systems. One key underlying problem is clinical inertia in general and therapeutic inertia (TI) in particular. TI refers to healthcare providers' failure to modify therapy appropriately when treatment goals are not met. TI therefore relates to the prescribing decisions made by healthcare professionals, such as doctors, nurses, and pharmacists. The known causes of TI include factors at the level of the physician (50%), patient (30%), and health system (20%). Although TI is often multifactorial, the literature suggests that 28% of strategies are targeted at multiple levels of causes, 38% at the patient level, 26% at the healthcare professional level, and only 8% at the healthcare system level. The most effective interventions against TI are shorter intervals until revisit appointments and empowering nurses, diabetes educators, and pharmacists to review treatments and modify prescriptions.

Keywords: Diabetes mellitus; Medication adherence; Therapeutics.

Fig. 1.

The “double valleys” of challenges in diabetes care for good outcomes. ^aPatient’s favourable outcomes depend on self-management and health behaviours such as that enhance physical health and emotional resilience stemming from will power and health beliefs; ^bPhysicians performance depends on knowledge in diabetes care and attitudes of the physician towards patients under their care; ^cGood outcomes are defined as achievement of treatment targets, healthy lifestyles, and good quality of life; ^dPoor outcomes are defined as the opposite of the good outcomes; ^eThis attitude is affected by the attitudes of the treating physicians and delivery of the healthcare services; ^fPatient’s health behaviours are formed from health beliefs, own health knowledge (literacy) and that of their physicians that may affect patient’s motivation.