Adherence to treatment guidelines in two primary care populations with gout

Rheumatol Int. 2010 Apr;30(6):749-53. doi: 10.1007/s00296-009-1056-7. Epub 2009 Jul 10.


Published guidelines for the treatment of gout aim to improve the evidenced-based management of this disorder. Unfortunately, several studies suggest that these guidelines are not routinely followed in clinical practice. Limited data exist comparing different groups of primary care providers regarding compliance with published gout guidelines. We conducted a retrospective study comparing two different general internal medicine (IM) practices and evaluated compliance with these guidelines. All patients with a billing code for gout seen in two large IM clinics (Clinic A, an inner-city urban clinic, and Clinic B, a suburban clinic) between January 2004 and December 2007 were selected for chart review. Patients referred to a rheumatologist for management of gout were excluded. The care received by these patients for gout was compared to recommendations from published guidelines, with the primary outcome assessing the percentage of patients who received at least yearly monitoring of serum uric acid (SUA) levels. In both clinics, yearly monitoring of SUA levels occurred in approximately one quarter of the patients with gout (Clinic A 27.5% vs. Clinic B 28.9%, P = 0.87). Compared to SUA, renal function was monitored more frequently in each of the groups. Listed indications for antihyperuricemic therapy were similar between groups, although gouty flares were reported more frequently in clinic B (P = 0.005). In this retrospective review of gout management in two IM clinics, general care for patients with this condition did not differ significantly. However, overall compliance with recommendations from published guidelines was low.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ambulatory Care Facilities / standards
  • Ambulatory Care Facilities / statistics & numerical data*
  • Biomarkers / analysis
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Gout / blood
  • Gout / therapy*
  • Guideline Adherence / standards
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Internal Medicine / standards
  • Internal Medicine / statistics & numerical data
  • Male
  • Monitoring, Physiologic / standards
  • Monitoring, Physiologic / statistics & numerical data
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care / standards
  • Primary Health Care / statistics & numerical data*
  • Quality Assurance, Health Care / methods
  • Quality of Health Care / standards
  • Quality of Health Care / statistics & numerical data
  • Renal Insufficiency / diagnosis
  • Renal Insufficiency / etiology
  • Retrospective Studies
  • Uric Acid / analysis
  • Uric Acid / blood


  • Biomarkers
  • Uric Acid