Clinical inertia: Overcoming a major barrier to diabetes management

Background:Clinical inertia is a major and pervasive factor in diabetes management.Objective:In this brief overview, some of the contributing factors to clinical inertia will be explored, along with some practical guidelines to help busy practitioners avoid this pitfall.Methods:English-language articles were identified through a search of MEDLINE and Google (1990–2006) using the search terms clinical inertia, diabetes, patient noncornpliance, and advancing therapy.Results:Clinical inertia has been defined as “the recognition of the problem, but failure to act.” Three simple strategies could enhance the ability of the busiest of primary care physicians to consistently and accurately assess care, to avoid being pulled off task by “soft” reasons for not acting, and to organize in order to better achieve goals. First, formally establish a defined goal for the glycosylated hemoglobin (A1C) value and consistently work toward it. Second, establish a time frame for achievement of this A1C goal. Finally, publicly display your progress toward achieving this goal (ie, have the results visible to you and your patient at all times during the follow-up).Conclusions:Although various psychological and system barriers can slow the physician from rapidly achieving established therapeutic goals, the simple strategies outlined here can eliminate many of the confounding factors that hinder aggressive managcmcnt.