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.
Similar content being viewed by others
References
Terkeltaub RA (2003) Gout. N Engl J Med 349:1647–1655. doi:10.1056/NEJMcp030733
Arromdee E, Michet CJ, Crowson CS, O’Fallon WM, Gabriel SE (2002) Epidemiology of gout: is the incidence rising? J Rheumatol 29:2403–2406
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
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
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
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
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
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
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
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
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
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
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
Corresponding author
Rights 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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-009-1056-7