The management of gout at an academic healthcare center in Beijing: a physician survey.
OBJECTIVE
Gout is a less commonly diagnosed rheumatic disease in China compared with Western countries, but its prevalence appears to be climbing. It is not known how Chinese physicians diagnose and treat their patients with gout, so we evaluated physician management of gout at a major academic healthcare center in Beijing, and investigated factors associated with better decision-making.


METHODS
A 13-question anonymous survey was distributed and collected at a medical grand rounds and then at a rheumatology grand rounds at a major teaching hospital in Beijing. Physician demographic data including educational background, work experience, job titles, specialty or subspecialties, gout patient volume seen in a year, and continuing medical education (CME) in gout were also collected in the survey. Data were analyzed by multivariate regression models to identify factors associated with appropriate answers.


RESULTS
Twenty-seven residents and general internists, 26 rheumatologists and fellows, and 28 physicians and fellows of other medical subspecialties from the Department of Medicine including visiting physicians responded to the survey. Among respondents, 78% think it is important for a definitive diagnosis of gout, but few actually perform aspiration of the affected joint fluid. Eighty-four percent report that they often follow the serum urate level of their patients with diagnosed gout. When treating acute gout in otherwise healthy patients, most physicians (77%) prefer oral colchicine, and in patients with renal impairment, about half of them (48%) choose corticosteroids or corticotropin as their first treatment. For longterm urate-lowering therapy, most physicians (87%) described a variety of indications that we consider less appropriate. They (86%) tend to initiate it early (< 2 weeks) after acute flares. When urate-lowering therapy is used, 80% of physicians sustain it less than 5 years. Further, only 12% of physicians use antiinflammatory prophylaxis during the initiation of urate-lowering treatment, and only 5% maintain it for an appropriate period of time. Logistic regression analysis of physician demographic data, educational background, and work experience found no consistent independent factors associated with better decision-making, other than CME, that were associated with establishing the definite diagnosis correctly. Specifically, the number of gout patients seen by physicians was not related to better decision-making.


CONCLUSIONS
The physicians' reported management of gout at this major academic healthcare center in Beijing was often inconsistent with current evidence. High quality CME is required to improve Chinese physician management of gout.
Fang
Weigang
W
Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Zeng
Xuejun
X
Li
Mengtao
M
Chen
Lan X
LX
Schumacher
H Ralph
HR
Zhang
Fengchun
F
D000046:Academic Medical Centers; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use*; D000328:Adult; D002681:China; D003078:Colchicine / Q000627:therapeutic use*; D003657:Decision Making; D004502:Education, Medical, Continuing / Q000639:trends; D005260:Female; D006073:Gout / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D006074:Gout Suppressants / Q000627:therapeutic use*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013038:Specialization; D013582:Synovial Fluid / Q000378:metabolism; D014527:Uric Acid / Q000097:blood; D014528:Uricosuric Agents / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D006074:Gout Suppressants; D014528:Uricosuric Agents; D014527:Uric Acid; D000324:Adrenocorticotropic Hormone; D003078:Colchicine