Date of Award

2024

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Teresa Van Winkle

Readers

Bonnie Bowie

Abstract

Objective:

Therapeutic inertia (TI) is the failure to initiate or make adjustments to the pharmacologic therapy of diabetic patients, when indicated, by generally recognized guidelines. It is an impediment to achieving A1C targets and ultimately a cause of poor patient outcomes. The purpose of this study is to determine if there are common characteristics among a health center’s primary care providers (PCPs) with high levels of TI.

Study Design:

Observational retrospective and quantitative chart review.

Methods:

From a list of all providers with diabetic patients, PCPs were ranked by what percent of their diabetic patients had an A1C >9% and were not on either insulin or GLP-1. Three cohorts were then created: highest TI, moderate TI, lowest TI. Pre-determined characteristics of the members of these groups were compared to determine if there were correlations.

Results:

The cohort with the most TI had a panel average of 531.75 patients, 99.5 of which were diabetic, and with a mean TI percentage of 42.23. The cohort with the lowest amount of TI had a mean of 446.174 patients, 64.25 of which were diabetic, and a mean TI percentage of 9.82. Additionally, 50.00% of PCPs with a low level of TI have received state of Washington credentials in the past 1-5 years, compared to 25.00% of PCPs with a high level of TI.

Conclusions:

Individual characteristics do not have an undue influence on rates of TI; however, the best predictor of TI is a higher overall patient panel load. Recommendations to reduce TI include determining the optimum patient panel size, evenly distributing diabetic patients amongst PCPs, providing continuing education on new therapies such as GLP-1RAs, and an examination into whether PCP behaviors, when treating diabetic patients, are associated with higher levels of TI.

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