Actionable Insights Newsletter

Translating research to power whole health

Issue 10   |    November 2024

Study highlights clinical inertia
in implementing ADA diabetes care standards despite high guideline knowledge among clinicians treating patients with T2D

Many clinicians did not consistently apply recommendations, indicating a need for additional interventions beyond medical education to improve guideline-based care.

Enterprise Analytics Core domain(s): cardiometabolic

Summary

Background
Evidence-based clinical practice guidelines (CPGs) are written to assist clinicians with standardizing and improving patient care. Studies show that up to 70% of clinicians are reluctant to implement these evidence-based guidelines. Although there is much research about clinicians’ knowledge and opinions of CPGs, there is little understanding of how these opinions and knowledge are actually applied to treatment decisions.

Objective
To gain insights into clinicians’ guideline attitudes, knowledge, and treatment behaviors related to the overall American Diabetes Association (ADA) standards of care in Diabetes CPGs with a focus on cardiorenal conditions.

Methods
An online survey was conducted with healthcare clinicians (primary care physicians, endocrinologists, physician assistants, and nurse practitioners) who treated at least 5 Elevance Health members with type 2 diabetes (T2D) between 11/30/19 and 11/30/21. These clinicians were identified through medical claims in the Healthcare Integrated Research Database (HIRD®).

The survey assessed clinicians’ attitudes, knowledge, and use of ADA CPGs for treating patients with T2D, including those with cardiorenal disease. After the survey, clinicians’ treatment behaviors were assessed using six therapeutic measures (TMs) based on patients’ claims data. Two TMs were related to lab tests (HbA1c and kidney function), and four were related to medication prescribing (for heart disease, kidney disease, or heart failure).

Each clinician received a guideline knowledge (GK) score, categorized as high GK (>80% correct) or low GK (<80% correct). For each TM, the proportion of patients receiving guideline-compliant care was calculated. Clinicians were categorized as high TM behavior (>75% compliance) or low TM behavior (<75% compliance).

Clinicians were grouped based on their GK scores and TM behaviors (Figure 1A-F):
1. Guideline inertia: high GK, low TM compliance
2. Guideline naïve: low GK, low TM compliance
3. Guideline implementation: high GK, high TM compliance
4. Residual: low GK, high TM compliance

Results

• Of the 402 clinician respondents, 260 (65%) were primary care physicians, 44 (11%) endocrinologists, and 98 (24%) physician assistants/nurse practitioners.

• Overall, at least 80% of all clinicians somewhat or strongly agreed that CPGs are good educational tools (83%), not meant to be a replacement for clinical judgment (83%), useful at various stages of diseases (82%), and evidence-based (81%).

• Over three-fourths of the endocrinologists had GK scores above 80% versus 60% of the physician assistants/nurse practitioners, and 58% of the primary care physicians.

• TM compliance behavior across all clinician types was highest for TM1 (HbA1c testing; >85%) followed by TM3 (prescribed statin; >72%). Clinicians’ TM compliance behavior was much lower for the other TM measures.
  

• Based on the concordance/discordance analysis, Figure 1A-F, shows:
  

• The guideline inertia group, consisting of >30% of clinicians, is the most prevalent group across all TMs, except TM1 (HbA1c testing)

• The guideline naïve group is the second most prevalent group, consisting of >30% of PCPs and PAs/NPs for all TM measures, except TM1 (HbA1c testing).

• The guideline implementation group is the third most prevalent group, consisting of >33% of endocrinologists for TM4-6, associated with medication therapy.

• The residual group is the smallest group, consisting of clinicians with low GK and high TM compliance behavior.

ADA: American Diabetes Association; SOC: Standard of Care; TM: Therapeutic Measure; GK: Guideline Knowledge; PCPs: Primary Care Physicians; Endos: Endocrinologists; PA/NPs: Physician Assistants/Nurse Practitioners

Key takeaways