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Acknowledging and allocating responsibility for clinical inertia in the management of Type 2 diabetes in primary care: a qualitative study
Author(s) -
Zafar A.,
Stone M. A.,
Davies M. J.,
Khunti K.
Publication year - 2015
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12592
Subject(s) - medicine , nonprobability sampling , qualitative research , thematic analysis , accountability , nursing , health care , perception , gatekeeping , family medicine , psychology , population , social science , environmental health , political science , law , economics , economic growth , neuroscience , sociology
Abstract Aims Failure to intensify treatment in patients with Type 2 diabetes with suboptimal blood glucose control has been termed clinical inertia and has been shown to contribute to poorer patient outcomes. We aimed to identify and explore perceptions about clinical inertia from the perspective of primary healthcare providers. Methods A qualitative study was conducted in Leicestershire and Northamptonshire, UK . Purposive sampling was based on healthcare providers working in primary care settings with ‘higher’ and ‘lower’ target achievement based on routine data. Twenty semi‐structured interviews were conducted, face‐to‐face or by telephone. Thematic analysis was informed by the constant comparative approach. Results An important broad theme that emerged during the analysis was related to attribution and explanation of responsibility for clinical inertia. This included general willingness to accept a degree of responsibility for clinical inertia. In some cases, however, participants had inaccurate perceptions about levels of target achievement in their primary care centres, as indicated by routine data. Participants sought to lessen their own sense of accountability by highlighting patient‐level barriers such as comorbidities and human fallibility, and also system‐level barriers, particularly time constraints. Perceptions about ways of addressing the problem of clinical inertia were not seen as straightforward, further emphasizing a complex and cumulative pattern of barriers. Conclusions In order to understand and address the problem of clinical inertia, provider, patient‐ and system‐level barriers should be considered together rather than as separate issues. Acknowledgement of responsibility should be regarded positively as a motivator for change.