Skip to main content

Advertisement

Log in

Adherence to treatment guidelines in two primary care populations with gout

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Terkeltaub RA (2003) Gout. N Engl J Med 349:1647–1655. doi:10.1056/NEJMcp030733

    Article  CAS  PubMed  Google Scholar 

  2. Arromdee E, Michet CJ, Crowson CS, O’Fallon WM, Gabriel SE (2002) Epidemiology of gout: is the incidence rising? J Rheumatol 29:2403–2406

    PubMed  Google Scholar 

  3. Mikuls TR, MacLean CH, Olivieri J, Patino F, Allison JJ, Farrar JT, Bilker WB, Saag KG (2004) Quality of care indicators for gout management. Arthritis Rheum 50:937–943. doi:10.1002/art.20102

    Article  PubMed  Google Scholar 

  4. Zhang W, Doherty M, Pascual E et al (2006) EULAR evidence based recommendations for gout. Part I: diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 65:1301–1311. doi:10.1136/ard.2006.055251

    Article  CAS  PubMed  Google Scholar 

  5. Zhang W, Doherty M, Bardin T et al (2006) EULAR evidence based recommendations for gout. Part II: management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 65:1312–1324. doi:10.1136/ard.2006.055269

    Article  CAS  PubMed  Google Scholar 

  6. Sarawate CA, Brewer KK, Yang W et al (2006) Gout medication treatment patterns and adherence to standards of care from a managed care perspective. Mayo Clin Proc 81:925–934. doi:10.4065/81.7.925

    Article  PubMed  Google Scholar 

  7. Pal B, Foxall M, Dysart T, Carey F, Whittaker M (2000) How is gout managed in primary care? A review of current practice and proposed guidelines. Clin Rheumatol 19:21–25. doi:10.1007/s100670050005

    Article  CAS  PubMed  Google Scholar 

  8. Mikuls TR, Farrar JT, Bilker WB, Fernandes S, Saag KG (2005) Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD). Rheumatology (Oxford) 44:1038–1042. doi:10.1093/rheumatology/keh679

    Article  CAS  Google Scholar 

  9. Sarawate CA, Patel PA, Schumacher HR et al (2006) Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol 12:61–65. doi:10.1097/01.rhu.0000209882.50228.9f

    Article  PubMed  Google Scholar 

  10. Hanly JG, Skedgel C, Sketris I et al (2009) Gout in the elderly—a population health study. J Rheumatol 36:822–830. doi:10.3899/jrheum.080768

    Article  PubMed  Google Scholar 

  11. Siegel D, Lopez J, Meier J, Goldstein MK, Lee S, Brazill BJ, Matalka MS (2003) Academic detailing to improve antihypertensive prescribing patterns. Am J Hypertens 16:508–511. doi:10.1016/S0895-7061(03)00060-8

    Article  PubMed  Google Scholar 

  12. Bailey TC, Noirot LA, Blickensderfer A, Rachmiel E, Schaiff R, Kessels A, Braverman A, Goldberg A, Waterman B, Dunagan WC (2007) An intervention to improve secondary prevention of coronary heart disease. Arch Intern Med 167:586–590. doi:10.1001/archinte.167.6.586

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

This study was sponsored by an unrestricted grant from Takeda Pharmaceuticals. The authors had complete control over study design, data collection and analysis, manuscript development, and the decision to publish. The authors have no other real or potential conflicts to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Geoffrey C. Wall.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wall, G.C., Koenigsfeld, C.F., Hegge, K.A. et al. Adherence to treatment guidelines in two primary care populations with gout. Rheumatol Int 30, 749–753 (2010). https://doi.org/10.1007/s00296-009-1056-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-009-1056-7

Keywords

Navigation