Management Of Gout In Physicians In Beijing:A Questionnaire Survey

Background:Recent studies on the mechanism,diagnosis and treatment of gout have continued to make new progress.However,the management of gout has not improved significantly.Western research reported poorly management,with insufficient patient evaluation,inappropriate use of antalgics and urate-lowering therapy(ULT),poor patient adherence,etc.With the development of hierarchical medical system in China,most patients with chronic diseases will be managed by primary care physicians(PCPs).Therefore,it is crucial for physicians,especially PCPs,to have adequate knowledge of gout.Objective:To provide more useful continued medical education(CME)for physicians and improve gout treatment,we conducted a questionnaire survey to investigate the gout-related knowledge of physicians(including PCPs)in nine districts of Beijing.Methods:A questionnaire survey,including ten gout-related questions(1 score for each),was conducted among physicians in Beijing.Demographic data was collected,like gender,age,working seniority,professional title,specialty or subspecialty,the number of gout patients visits per year,gout knowledge level(marked on 0-10 scale),previous gout CME experience,ULT medications and gout tests/imaging available in local centers.The mean ± standard deviation or percentage were calculated.Chi-square test or student t test,single factor and multivariate regression analysis were used to analysis the relevant factors affecting the gout-related knowledge level.Results:298 copies of questionnaire were sent and 250 valid copies were collected(127 in community service centers(CSC),123 in tertiary hospitals).65.1%of CSC did not have ULT medications and 75.0%of them did not carry out gout imaging or synovial fluid analysis service.Difference was statistically significant comparing to tertiary hospital(P<0.01).Average correct answer rate among CSC and tertiary hospital doctors were 6.6±1.9 and 7.2±2.0 respectively(P=0.026).The correct answer rate in the knowledge about etiology,pathogenesis and gout attack symptoms were over 70%in both groups.Especially about etiology,the correct answer rate was near 100%.45.5%of CSC doctors and 57.4%of tertiary hospital doctors knew the right drug to use in acute gout attack.Only 42.3%in CSC and 53.4%in hospitals chose allopurinol as a urate-lowering drug,while more than 1/3 of all the doctors considered colchicine as ULT drug.A mere half of them thought gout patient should take urate-lowering drugs for life(40.5%Vs 57.6%).About 60%of doctors understood that high blood pressure is common in gout patients.Single factor Logistic regression analysis showed that CME can improve the level of gout-related knowledge.Conclusion:Most CSC doctors generally understood the causes and symptoms of gout,while lacking in the knowledge of treatment.CME of gout treatment should be carried out to improve the management of gout in primary care.