Background Gout is the most frequent inflammatory arthritis in males, and therefore a common cause for consultation in both primary care and specialist settings. Despite its frequency, the diagnosis and treatment for this condition are far from desirable (1, 2). There is evidence of gout management improvement through educational programs targeted at primary care physicians (3).
Objectives To measure the impact in diagnostic and therapeutic attitudes towards patients with gout, in primary care physicians, before and after performing an educational intervention based on a clinical case.
Methods Through a training program aimed at general physicians with interest in musculo-skeletal diseases, an initiative of the Sociedad Española de Reumatología [Spanish Rheumatology Society] and the Sociedad Española de Médicos de Atenciόn Primaria [Spanish Society for Primary Care Physicians], sessions were held in 6 Spanish locations. In the sessions, a general physician presented a clinical case about a patient with hyperuricaemia, intermittent arthritis, condrocalcinosis in knee joints and several associated comorbidities. In first place, 5 questions with multiple-choice answers were formulated, regarding the diagnosis and treatment deemed appropriate. Later, the case was evaluated and discussed by a rheumatologist, and the same questions were repeated.
Answers were recorded by electronic means.
Results A total of 195 physicians, divided in 6 locations, attended the sessions. Statistically significant results for each evaluated area are summarized below:
Diagnosis: initially 21.8% of the attendants deemed arthrocentesis necessary for the diagnosis, but complementary investigations appeared to be more important (67.3%). Afterwards, a significant increase in the need for arthrocentesis was observed (46.7%).
Comorbidities: 52.6% of the attendants decided to prescribe a non-steroidal anti-inflammatory drug (NSAID) to the fictional patient, with chronic kidney disease. After the discussion, the broad majority of assistants opted for alternatives such as steroids (41.23%) and only 4.74% still preferred NSAIDs.
Initial complexity for diagnosis: a small percentage (12.7%) considered that a solid diagnosis was not possible without a sample of synovial fluid. This percentage rose up to 55.5% after the intervention.
Prophylaxis: Colchicine-based prophylaxis was prescribed initially by 57.4% of physicians, and after the session, by most of them (71.6%).
Urate lowering drugs: A change was observed in the use of urate lowering medications, from an initial 64.7%, up to 85.1% after the discussion.
There was a reduction in the number of referrals to specialists, but it was not statistically significant.
Conclusions Through educational initiatives for primary care physicians it is possible to optimize the perception of diagnosis and treatment of patients with gout.
Ogdie AR, Hoch S, Dunham J, Von Feldt JM. A roadmap for education to improve the quality of care in gout. Curr Opin Rheumatol. 2010 Mar;22(2):173–80.
Roddy E, Mallen CD, Hider SL, Jordan KP. Prescription and comorbidity screening following consultation for acute gout in primary care. Rheumatology (Oxford). 2010 Jan;49(1):105–11.
Weaver AL, Cheh MA, Kennison RH. How PCP education can impact gout management: the gout essentials. J Clin Rheumatol. 2008 Oct;14(5 Suppl):S42–6.
Disclosure of Interest S. Chinchilla: None declared, I. Urionagüena Onaindia: None declared, F. Perez-Ruiz Grant/research support from: Fundaciόn Española de Reumatología; Asociaciόn de Reumatόlogos del Hospital de Cruces, Consultant for: Menarini, AstraZeneca, Speakers bureau: Menarini, AstraZeneca, J. Ugarriza Ortueta: None declared
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