Clinician Perceptions of Therapeutic Inertia in Type 2 Diabetes Mellitus: A Qualitative Study

Therapeutic inertia (TI) in type 2 diabetes mellitus (T2DM) is defined as the lack of timely adjustment to therapy when a patient's treatment goals are not met. Failure to initiate or intensify evidence-based therapies for T2DM increases the risk of micro and macrovascular disease complications. There are limited data regarding clinicians' (nurse practitioners and pharmacists) perceptions of TI and patient-perceived barriers to therapeutic progress in T2DM. A better understanding of perceptions of TI might assist in identifying targeted interventions to limit its occurrence. The objective of this study was to determine perceived factors that contribute to TI in patients with T2DM from a primary care clinician perspective.

This was a multi-centered prospective qualitative study. Purposive sampling was used. Primary care clinicians, licensed in the state of Michigan and treating patients with T2DM, were assessed on their attitudes and beliefs toward TI in the treatment of T2DM. Participant interviews were conducted by one investigator, and responses were independently reviewed by two separate investigators. Data were coded, organized, and analyzed using Dedoose software.

Fourteen participants completed the study. Clinicians in the study were predominately pharmacists (57.1%) and female (92.9%) and the majority had more than 10 years of practice experience (57.1%). Major themes identified to help overcome TI were the importance of patient education, empathy toward the patient, and team collaboration. Therapeutic barriers identified by clinicians included cost, clinician/clinic time, and patient accountability. Several perceived facilitators and barriers to TI in the management of T2DM were identified. Clinicians described a team-based approach with clearly delineated and complementary roles between clinicians to support patient care and minimize TI.

TI remains a persistent problem in clinical practice. Several opportunities exist to reduce TI in patients with T2DM, which include a multidisciplinary approach to care and improved access to medications and services (transportation, nutrition education, etc.).