Background: The prevalence of gout has risen in recent decades despite advancements in therapeutic options due to several reasons, including lack of adherence to treatment guidelines by physicians and patients’ poor perception and adherence to therapy. We aim to assess the beliefs and knowledge of gout management in Internal Medicine residents, to investigate the gaps, so that education programs can target these gaps and address them in a comprehensive fashion.
Methods: A cross-section survey of Internal Medicine residents from three residency programs in Chicago was conducted using a 20-item questionnaire based on current ACP guidelines on gout management. Residents were considered to have “good” knowledge if 70% of the questions are answered correctly. Survey performance was compared to respondent’s’ year in residency, information on guidelines, number of teaching sessions attended, and number of gout patients cared for. We obtained adjusted relative risks (RRs) of good knowledge by estimating a multivariable Poisson regression model with robust variance estimates, adjusted for covariates. Analyses were conducted using Stata, version 14.2.
Results: Of the original sample of 150 residents, 126 (84%) responded to the survey. Good knowledge was demonstrated by only 40% of the respondents. In our survey, two-third of the residents reported that their teaching on gout management is inadequate. For acute gout attacks, 70% of the respondents recognized the right therapeutic options. Only half of the residents knew the correct dose of colchicine and other half opted regimens accounting for higher dose of >2 mg/day. During an acute attack, urate-lowering therapy(ULT) was continued by approximately three-quarters (73%) of the residents. Half of the respondents (50%) were aware that anti-inflammatory prophylaxis (54% colchicine) was indicated while initiating ULT, but only one-third offered the prophylaxis for ≥8 weeks. Approximately 60% of residents reported that allopurinol is initially dosed according to the renal function, but only one third (33%) were aware that it must be titrated to the target serum urate level. Less than half (46%) considered the target serum urate level to be less than 6 mg/dl. In multivariable regression analysis, gout related knowledge was found to be higher among residents who attended more than 3 teaching sessions (RR-3.1; P=0.03;95% CI,1.09 to 10.9) and who read the guidelines(ACR/ACP/EULAR) on management (RR-1.8; P=0.04; 95% CI,1.87 to 4.00).
Conclusions: Our study suggests that better dissemination of knowledge on gout management to Internal Medicine physicians in training is needed. We have identified several areas that should be focused: 1) avoidance of high-dose colchicine; 2) initiating anti-inflammatory prophylaxis while starting urate lowering therapy and its duration; 3) initial dosing of allopurinol 4) target serum urate level; and 4) the need to titrate allopurinol to target serum urate level. Academic hospitalists can conduct teaching sessions targeting these knowledge gaps which may lead to better management practices of the upcoming physicians and help in reducing the prevalence of this burdensome disease and reduce the healthcare costs.