title: Primary care providers' knowledge, beliefs and treatment practices for gout: results of a physician questionnaire.
abstract: OBJECTIVE
  We sought to examine primary care providers' gout knowledge and reported treatment patterns in comparison with current treatment recommendations.
  
  
  METHODS
  We conducted a national survey of a random sample of US primary care physicians to assess their treatment of acute, intercritical and tophaceous gout using published European and American gout treatment recommendations and guidelines as a gold standard.
  
  
  RESULTS
  There were 838 respondents (response rate of 41%), most of whom worked in private practice (63%) with >16 years experience (52%). Inappropriate dosing of medications in the setting of renal disease and lack of prophylaxis when initiating urate-lowering therapy (ULT) accounted for much of the lack of compliance with treatment recommendations. Specifically for acute podagra, 53% reported avoidance of anti-inflammatory drugs in the setting of renal insufficiency, use of colchicine at a dose of ≤2.4 mg/day and no initiation of a ULT during an acute attack. For intercritical gout in the setting of renal disease, 3% would provide care consistent with the recommendations, including initiating a ULT at the appropriate dose with dosing titration to a serum urate level of ≤6 mg/dl and providing prophylaxis. For tophaceous gout, 17% reported care consistent with the recommendations, including ULT use with dosing titration to a serum urate level of ≤6 mg/dl and prophylaxis.
  
  
  CONCLUSIONS
  Only half of primary care providers reported optimal treatment practices for the management of acute gout and <20% for intercritical or tophaceous gout, suggesting that care deficiencies are common.
authors.affiliation: Department of Orthopedics, University of Massachusetts Medical School, Worcester, MA 01655, USA. leslie.harrold@umassmed.edu
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Harrold
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.forename: Amarie
authors.initials: A
authors.lastname: Negron
authors.forename: Jessica
authors.initials: J
authors.lastname: Ogarek
authors.forename: Cassandra
authors.initials: C
authors.lastname: Firneno
authors.forename: Robert A
authors.initials: RA
authors.lastname: Yood
mesh_terms: D005260:Female; D006073:Gout / Q000097:blood / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014481:United States; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid
keywords: gout knowledge; medication use; treatment practices