Oderda Gary M, Shiozawa Aki, Walsh Michael, Hess Kyle, Brixner Diana I, Feehan Michael, Akhras Kasem
Professor and Director, Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT.
Postgrad Med. 2014 May;126(3):257-67. doi: 10.3810/pgm.2014.05.2774.
In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy.
Identify potential gaps between real-world chronic gout treatment, ACR guideline recommendations, and physicians' perceived guideline adherence by evaluating records of patients classified as having "higher" and "lower" guideline adherence as defined by the investigators.
A comprehensive quantitative survey was administered between February 11 and February 22, 2013, to physicians treating patients with gout; the survey included a patient record chart review informed by prior qualitative interviews. Eight criteria from the ACR gout management guidelines were used to compose the survey. To assess ACR guideline adherence, information from records of patients with chronic gout treated by primary care physicians (PCPs) and rheumatologists was scored from 0 (no adherence) to 8 (total adherence), in accordance with ACR guideline recommendations. Physicians also indicated how closely they believed patient treatment followed current guidelines on a 10-point scale.
Of the 350 records of patients with chronic gout, all but 3 PCP patients were adherent on ≥ 1 guideline recommendation, but nearly all patients could be considered nonadherent, considering all potential recommendations. Patients with chronic gout treated by rheumatologists tended to be managed more closely to ACR guidelines than patients treated by PCPs (mean scores: rheumatologists 5.8/8 ± 1.7 vs 4.3/8 ± 1.7 for PCPs). Among patients classified as having "higher adherence" based on adherence scores, there was low adherence on first-line urate lowering therapy dose, acute prophylaxis dosing, and length of prophylaxis treatment. Among PCPs and rheumatologists, there was a disparity between how closely physicians believed patient treatment followed guidelines and actual adherence with ACR guidelines based on adherence scores. For 16.4% of patients treated by PCPs and 18.4% of patients seen by rheumatologists, physicians believed they closely followed ACR guidelines (score of 8-10/10) for each patient; but in actuality, adherence was lower.
Although adherence with ACR guidelines is higher among rheumatologists than PCPs in treating patients with gout, overall adherence could be improved by both specialties.
2012年10月，美国风湿病学会（ACR）发布了慢性痛风治疗目标和药物治疗的建议。
通过评估被研究者定义为“较高”和“较低”指南依从性的患者记录，确定现实世界中慢性痛风治疗、ACR指南建议以及医生所认为的指南依从性之间的潜在差距。
2013年2月11日至2月22日对治疗痛风患者的医生进行了一项全面的定量调查；该调查包括根据先前的定性访谈进行的患者记录图表审查。使用ACR痛风管理指南的八项标准来编制调查。为评估ACR指南依从性，根据ACR指南建议，对初级保健医生（PCP）和风湿病学家治疗的慢性痛风患者记录中的信息从0（无依从性）到8（完全依从性）进行评分。医生还以10分制表明他们认为患者治疗遵循当前指南的程度。
在350份慢性痛风患者记录中，除3名PCP患者外，所有患者都至少符合1项指南建议，但考虑到所有潜在建议，几乎所有患者都可被视为未依从。与PCP治疗的患者相比，风湿病学家治疗的慢性痛风患者往往更严格地遵循ACR指南（平均得分：风湿病学家5.8/8±1.7，PCP为4.3/8±1.7）。在根据依从性评分被归类为“较高依从性”的患者中，一线降尿酸治疗剂量、急性预防用药剂量和预防治疗时长的依从性较低。在PCP和风湿病学家中，医生认为患者治疗遵循指南的程度与基于依从性评分的ACR指南实际依从性之间存在差异。对于PCP治疗的16.4%的患者和风湿病学家诊治的18.4%的患者，医生认为他们对每位患者都严格遵循了ACR指南（评分8 - 至10/10）；但实际上，依从性较低。
虽然在治疗痛风患者方面，风湿病学家比PCP对ACR指南的依从性更高，但两个专业的总体依从性都有待提高。
