Adherence to treatment guidelines in two primary care populations with gout

Abstract

Published guidelines for the treatment of gout aim to improve the evidenced-based management of this disorder. Unfortunately, several studies suggest that these guidelines are not routinely followed in clinical practice. Limited data exist comparing different groups of primary care providers regarding compliance with published gout guidelines. We conducted a retrospective study comparing two different general internal medicine (IM) practices and evaluated compliance with these guidelines. All patients with a billing code for gout seen in two large IM clinics (Clinic A, an inner-city urban clinic, and Clinic B, a suburban clinic) between January 2004 and December 2007 were selected for chart review. Patients referred to a rheumatologist for management of gout were excluded. The care received by these patients for gout was compared to recommendations from published guidelines, with the primary outcome assessing the percentage of patients who received at least yearly monitoring of serum uric acid (SUA) levels. In both clinics, yearly monitoring of SUA levels occurred in approximately one quarter of the patients with gout (Clinic A 27.5% vs. Clinic B 28.9%, P = 0.87). Compared to SUA, renal function was monitored more frequently in each of the groups. Listed indications for antihyperuricemic therapy were similar between groups, although gouty flares were reported more frequently in clinic B (P = 0.005). In this retrospective review of gout management in two IM clinics, general care for patients with this condition did not differ significantly. However, overall compliance with recommendations from published guidelines was low.

Gout: why is this curable disease so seldom cured?

“…The low adherence of primary care physicians to published evidence-based treatment guidelines for the diagnosis and management of gout57 undoubtedly reflects inadequate dissemination of these guidelines. Contributing factors may include the lack of involvement of GPs in guideline development, publication of guidelines only in specialist rheumatology journals (even though GPs are the main target audience) and the absence of financial incentives to audit and improve standards of care.…”

Tophaceous gout in the elderly: a clinical case review

“…There is also evidence of nonspecialist physicians prescribing inappropriate drugs for gout, which prove ineffective in the long term [12]. Compliance with gout treatment guidelines in primary care is reportedly poor, with limited numbers of patients achieving the target of serum uric acid levels <0.36 mmol/l as a consequence [13]. Physicians are also frequently unaware of their gout patients' poor compliance due to inadequate communications, and patient compliance would probably benefit if patients had more information and a closer interaction with their care providers [14].…”

Treatment approaches and adherence to urate-lowering therapy for patients with gout

“…However, Wall et al showed in their study that in primary care settings, where most gout patients are treated, serum urate is monitored yearly in only one-quarter of patients 15. Other studies have shown that fewer than 50% of patients met the goal urate level within 6 months or were flare free within 12 months 16,17.…”