Working without patients

A new strategy to improve the glycemic control in patients with type 2 diabetes. Avoiding therapeutic inertia

Abstract

Background: Inertia has been described as one of the causes of persistent poor glycemic control. The aim of this study was to evaluate, after one year of implementation in a health area, the effect of an intervention to improve the degree of glycemic control of patients with type 2 diabetes (DM2).

Methods: A pre-post intervention study was carried out in one health department during 2018. Health department with 222,767 inhabitants, 111 primary care physicians and 14,154 patients with DM2. Each primary care physician reviewed, outside consultation hours (“working without patients”), the electronic health record to identify patients with DM2 and with poor glycemic control, and they cited them for review. The glycemic control for the month of December 2017 and 2018 were compared, defined as the percentage of patients who reach the control objective of glycosylate hemoglobin (HbA1c).

Results: The proportion of patients with good glycemic control was 44.8% in 2017 and 50.1% in 2018, being the department that obtained the greatest improvement in the indicator in 2018 in the Valencian Community. The proportion of primary care physicians that had at least half of their patients with good glycemic control increased from 39% to 51% after the intervention.

Conclusions: The strategy “working without patients” was associated with an improvement in the degree of glycemic control of patients with DM2.