Physician adherence to ACR gout treatment guidelines: perception versus practice

Area of Science:

• Rheumatology
• Clinical Practice Guidelines
• Gout Management

Background:

• The American College of Rheumatology (ACR) published chronic gout treatment guidelines in October 2012.
• These guidelines cover treatment goals and pharmacotherapy for gout management.

Purpose of the Study:

• To identify gaps between real-world chronic gout treatment and ACR guideline recommendations.
• To assess physicians' perceived adherence to ACR guidelines.
• To evaluate patient records for "higher" and "lower" guideline adherence.

Main Methods:

• A quantitative survey with patient record chart review was conducted from February 11-22, 2013.
• Physicians treating gout patients (PCPs and rheumatologists) participated.
• Adherence was scored from 0-8 based on eight ACR guideline criteria.

Main Results:

• Rheumatologists managed gout patients closer to ACR guidelines (mean score 5.8/8) than PCPs (mean score 4.3/8).
• Despite high perceived adherence, actual adherence to specific recommendations (e.g., urate-lowering therapy dose, prophylaxis) was often low.
• A significant disparity existed between physicians' perceived and actual ACR guideline adherence.

Conclusions:

• Rheumatologists demonstrate higher adherence to ACR gout guidelines compared to PCPs.
• Opportunities exist to improve overall adherence to ACR guidelines in both primary care and rheumatology settings.
• Enhancing adherence can lead to better chronic gout treatment outcomes.