The Article in Brief

Competing Demands or Clinical Inertia: The Case of Elevated Glycosylated Hemoglobin

Michael L. Parchman, MD, MPH , and colleagues

Background Medication plays a key role in controlling blood sugars in diabetes patients. This study examines two possible reasons why primary care doctors might not change the medication of diabetes patients whose blood sugar is not well controlled: "clinical inertia" (recognizing but not acting on a medical problem), and "competing demands" (the need to address several medical problems, patient concerns, and preventive health measures in the limited time of a doctor visit).

What This Study Found Primary care doctors address and prioritize many medical issues during patient visits. As the number of medical issues raised by a patient with high blood sugar goes up, the likelihood of a change in their medication goes down. Compared with other doctor visits, those in which diabetes medication is changed are longer, and the patient has fewer medical concerns but a higher blood sugar. Doctors spend the same amount of time discussing self-care measures with patients who have high blood sugars, regardless of whether they change the medication.

Implications

• The ability to treat multiple conditions is a strength of primary care. Because multiple conditions present competing demands, the patient and doctor must set goals and priorities during their visits.
• Studies using the term "clinical inertia" usually focus only on diabetes care and not the patients’ other health care needs. As a result, approaches to diabetes care based on clinical inertia are likely to be ineffective.
• The concept of competing demands better describes the diabetes patient’s primary care visit than the concept of clinical inertia.