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Journal articles on the topic 'Family practice Practice guidelines'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Cohen-Stavi, Chandra J., Calanit Key, Shmuel Giveon, Tchiya Molcho, Ran D. Balicer, and Efrat Shadmi. "Assessing guideline-concordant care for patients with multimorbidity treated in a care management setting." Family Practice 37, no. 4 (March 27, 2020): 479–85. http://dx.doi.org/10.1093/fampra/cmaa024.

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Abstract Background Disease-specific guidelines are not aligned with multimorbidity care complexity. Meeting all guideline-recommended care for multimorbid patients has been estimated but not demonstrated across multiple guidelines. Objective Measure guideline-concordant care for patients with multimorbidity; assess in what types of care and by whom (clinician or patient) deviation from guidelines occurs and evaluate whether patient characteristics are associated with concordance. Methods A retrospective cohort study of care received over 1 year, conducted across 11 primary care clinics within the context of multimorbidity-focused care management program. Patients were aged 45+ years with more than two common chronic conditions and were sampled based on either being new (≤6 months) or veteran to the program (≥1 year). Measures Three guideline concordance measures were calculated for each patient out of 44 potential guideline-recommended care processes for nine chronic conditions: overall score; referral score (proportion of guideline-recommended care referred) and patient-only score (proportion of referred care completed by patients). Guideline concordance was stratified by care type. Results 4386 care processes evaluated among 204 patients, mean age = 72.3 years (standard deviation = 9.7). Overall, 79.2% of care was guideline concordant, 87.6% was referred according to guidelines and patients followed 91.4% of referred care. Guideline-concordant care varied across care types. Age, morbidity burden and whether patients were new or veteran to the program were associated with guideline concordance. Conclusions Patients with multimorbidity do not receive ~20% of guideline recommendations, mostly due to clinicians not referring care. Determining the types of care for which the greatest deviation from guidelines exists can inform the tailoring of care for multimorbidity patients.

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Clark, Christopher E., and John L. Campbell. "Hypertension guidelines." British Journal of General Practice 59, no. 563 (June 1, 2009): 448.2–449. http://dx.doi.org/10.3399/bjgp09x420978.

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Hares, Fiona, Daniel Menzies, Paul Brocklehurst, and Sion Williams. "How do you diagnose asthma? A multiple case study design to understand and explain current use of national guidelines by primary care clinicians." British Journal of General Practice 70, suppl 1 (June 2020): bjgp20X711485. http://dx.doi.org/10.3399/bjgp20x711485.

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BackgroundClinical guidelines for asthma are available to UK clinicians but implementation is not straightforward. Diagnostic and treatment inadequacy contribute to patient morbidity and mortality and lack of adherence to guidelines is a component of this.AimThis qualitative study sought to explore and understand the use of asthma guidelines by primary care clinicians in two geographically bounded regions of Wales.MethodMultiple case study design was used. Data was collected using semi-structured interviews with a purposively sampled group of clinical staff from GP practices. Interview transcripts were thematically analysed to produce a detailed picture of practice.ResultsAsthma care in the studied areas operated as a social network of clinicians who often used guidelines as boundary objects. Practice and local service design was influenced and dependent on regular input from local secondary care providers. Clinicians looked to British Thoracic Society and Scottish Intercollegiate Guideline Network (BTS/SIGN) 2016 guidelines. There was limited use of National Institute for Health and Care Excellence (NICE) 2017 guidelines. Barriers to guideline recommended diagnostic asthma care included: lack of acceptability, financial costs and disempowerment of nursing staff.ConclusionThe findings from this study replicate and reinforce the findings of previous work. It is striking and concerning that the thematic outcomes of this study bear a strong resemblance to that which was demonstrated over a decade ago. The guideline-implementation gap in asthma diagnostics will likely persist unless there is significant restructuring, financial investment and greater empowerment of nursing staff in primary care.

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Varonen, Helena, Jukkapekka Jousimaa, Arja Helin-Salmivaara, and Ilkka Kunnamo. "Electronic primary care guidelines with links to Cochrane reviews—EBM Guidelines." Family Practice 22, no. 4 (May 16, 2005): 465–69. http://dx.doi.org/10.1093/fampra/cmi029.

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5

&NA;. "Practice Guidelines for Family Nurse Practitioners." American Journal of Nursing 98, no. 3 (March 1998): 16DDD. http://dx.doi.org/10.1097/00000446-199803000-00024.

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Feisterinacher, Karen, and Barbara Toni Hudson. "Practice Guidelines for Family Nurse Practitioners." Nurse Practitioner 22, no. 10 (October 1997): 137. http://dx.doi.org/10.1097/00006205-199710000-00046.

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Sikorski, Andrew. "2014 NICE cholesterol guidelines." British Journal of General Practice 67, no. 663 (September 29, 2017): 446.2–446. http://dx.doi.org/10.3399/bjgp17x692729.

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Kennedy, Michael. "Problems with hypertension guidelines." British Journal of General Practice 63, no. 608 (March 2013): 126.2–127. http://dx.doi.org/10.3399/bjgp13x664153.

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Byrne, Paula, John Cullinan, Paddy Gillespie, Rafael Perera, and Susan M. Smith. "Statins for primary prevention of cardiovascular disease: modelling guidelines and patient preferences based on an Irish cohort." British Journal of General Practice 69, no. 683 (April 23, 2019): e373-e380. http://dx.doi.org/10.3399/bjgp19x702701.

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BackgroundChanges in clinical guidelines for primary prevention of cardiovascular disease (CVD) have widened eligibility for statin therapy.AimTo illustrate the potential impacts of changes in clinical guidelines.Design and settingModelling the impacts of seven consecutive European guidelines based on a cohort of people aged ≥50 years from the Irish Longitudinal Study on Ageing.MethodThe eligibility for statin therapy of a sample of people without a history of CVD was established, according to changing guideline recommendations and modelled associated potential costs. The authors calculated the numbers needed to treat (NNT) to prevent one major vascular event in patients at the lowest baseline risk for which each of the seven guidelines recommended treatment, and for those at low, medium, high, and very-high risk according to 2016 guidelines. These were compared with the NNT that patients reported as required to justify taking a daily medicine.ResultsThe proportion of patients eligible for statins increased from approximately 8% in 1987 to 61% in 2016; associated costs rose from €13.9 million to €107.1 million per annum. The NNT for those at the lowest risk for which each guideline recommended treatment rose from 40 to 400. By 2016, the NNT for low-risk patients was 400 compared to ≤25 very-high risk patients. The proportion of patients eligible for statins achieving NNT levels that patients regarded as justified to taking a daily medicine fell as guidelines changed over time.ConclusionIncreased eligibility for statin therapy impacts large proportions of the present population and healthcare budgets. Decisions to take and reimburse statins should be considered on the basis of expected cost-effectiveness and acceptability to patients.

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Gunn, Jane, Donna Southern, Patty Chondros, Philippa Thomson, and Kathryn Robertson. "Guidelines for assessing postnatal problems: introducing evidence-based guidelines in Australian general practice." Family Practice 20, no. 4 (August 2003): 382–89. http://dx.doi.org/10.1093/fampra/cmg408.

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Takher, Sandeep, Gillian Kyei, Pippa Oakeshott, and Sally Kerry. "GPs' attitudes to hypertension guidelines." British Journal of General Practice 58, no. 549 (April 1, 2008): 277.1–277. http://dx.doi.org/10.3399/bjgp08x279788.

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Lee, Jung Un. "Reporting Guidelines of Medical Research." Korean Journal of Family Medicine 30, no. 1 (2009): 1. http://dx.doi.org/10.4082/kjfm.2009.30.1.1.

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Parkes, Gary. "Asymptomatic COPD and NICE guidelines." British Journal of General Practice 61, no. 585 (April 1, 2011): 294.2–295. http://dx.doi.org/10.3399/bjgp11x567234.

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Vande Walle, Johan, Soren Rittig, Serdar Tekgül, Paul Austin, Stephen Shei-Dei Yang, Pédro-José Lopez, and Charlotte Van Herzeele. "Enuresis: practical guidelines for primary care." British Journal of General Practice 67, no. 660 (May 22, 2017): 328–29. http://dx.doi.org/10.3399/bjgp17x691337.

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Martin, Una. "Hypertension guidelines: thresholds, targets, and teratogenicity." British Journal of General Practice 58, no. 553 (August 1, 2008): 585. http://dx.doi.org/10.3399/bjgp08x319800.

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Adjei-Gyamfi, Yvette, Sally Kerry, Jennifer Tulloch, Denise Coster, and Pippa Oakeshott. "Use of evidence in hypertension guidelines." British Journal of General Practice 59, no. 563 (June 1, 2009): 448.1–448. http://dx.doi.org/10.3399/bjgp09x420969.

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Steffensen, Flemming Hald, Frede Olesen, and Henrik Toft Sørensen. "Implementation of guidelines on stroke prevention." Family Practice 12, no. 3 (1995): 269–73. http://dx.doi.org/10.1093/fampra/12.3.269.

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Paniagua, Freddy A. "Cross-Cultural Guidelines in Family Therapy Practice." Family Journal 4, no. 2 (April 1996): 127–38. http://dx.doi.org/10.1177/1066480796042005.

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Grol, Richard. "Setting and using guidelines for quality in general practice." European Journal of General Practice 1, no. 2 (January 1995): 87–89. http://dx.doi.org/10.3109/13814789509160771.

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De Maeseneer, Jan, and Anselm Derese. "Editorial: European general practice guidelines: a step too far?" European Journal of General Practice 5, no. 3 (January 1999): 86–87. http://dx.doi.org/10.3109/13814789909094269.

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Hodson, Nathan, Elizabeth Ford, and Maxwell Cooper. "Adherence to guidelines on documentation required for registration to London GP practice websites: a mixed-methods cross-sectional study." British Journal of General Practice 69, no. 687 (September 23, 2019): e731-e739. http://dx.doi.org/10.3399/bjgp19x705581.

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BackgroundThe most common obstacle to registration with a GP practice in the UK is difficulty presenting proof of address. NHS guidelines stipulate that inability to provide ID or proof of address is not reasonable grounds to refuse registration. Practices may ask patients to present ID/proof of address, but need a policy in case patients cannot.AimTo find out how many London GP practice websites ask for documentation without a policy for where this cannot be provided and compare how GP practice websites describe the registration process in patient-facing material.Design and settingCross-sectional study of practices from 10 London boroughs (n = 100).MethodA proforma was piloted and then implemented, recording whether practices ‘demanded’, ‘requested’, or ‘mentioned’ photo ID or proof of address and whether there was a plan for patients without documentation. Text relating to documentation from all 100 practices for registration was subjected to thematic analysis.ResultsOut of 100 practices 75% asked for documentation. The majority of these were ‘demanded’. A plan was included for people without documentation in 12% of practice websites. Five themes emerged from analysis of website content: reassuring people without documentation; diverse requirements between practices; conflating administration and treatment; withholding treatment; and immigration and ethnicity.ConclusionMany practice websites breached NHS Standard Operating Principles and possibly the Equalities Act 2010. All practices should create a clear policy for patients who do not have photo ID/proof of address (for example, including a named receptionist), and update their websites accordingly.

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Prins, A. D. "The challenge of European guidelines for prevention." European Journal of General Practice 5, no. 4 (January 1999): 134. http://dx.doi.org/10.3109/13814789909094284.

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Upshur, R. E. G. "Do Clinical Guidelines Still Make Sense? No." Annals of Family Medicine 12, no. 3 (May 1, 2014): 202–3. http://dx.doi.org/10.1370/afm.1654.

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Park, Minseon, Soo Young Kim, Young Sik Kim, Sung Sunwoo, and Jung Jin Cho. "Periodic Health Examination and Prevention Guidelines for Koreans." Korean Journal of Family Medicine 30, no. 10 (2009): 761. http://dx.doi.org/10.4082/kjfm.2009.30.10.761.

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Matthys, J., M. De Meyere, M. L. van Driel, and A. De Sutter. "Differences Among International Pharyngitis Guidelines: Not Just Academic." Annals of Family Medicine 5, no. 5 (September 1, 2007): 436–43. http://dx.doi.org/10.1370/afm.741.

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TROEIN, MARGARETA, LENNART RÅSTAM, and STAFFAN SELANDER. "Dissemination and Implementation of Guidelines for Lipid Lowering." Family Practice 8, no. 3 (1991): 223–28. http://dx.doi.org/10.1093/fampra/8.3.223.

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DeMoss, Dustin S., Kari J. Teigen, Cynthia A. Claassen, Mandy J. Fisk, Somer E. Blair, Sulaimon A. Bakre, Cheryl L. Hurd, and Augustus J. Rush. "Association between depression and hypertension using classic and revised blood pressure thresholds." Family Practice 37, no. 5 (June 17, 2020): 616–22. http://dx.doi.org/10.1093/fampra/cmaa010.

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Abstract Background In a primary care population, the relationship between treatment of depression and hypertension (HTN) under the recently revised American College of Cardiology and American Heart Association HTN thresholds for diagnosing HTN is unknown. Objective To compare the association between changes in severity of co-occurring depression and HTN over time using the newly revised versus previous HTN guidelines. Methods In this retrospective cohort study, outpatients ≥18 years (n = 3018) with clinically significant depressive symptoms and elevated blood pressure at baseline were divided into a ‘revised’ guideline group (baseline blood pressure ≥130/80 mmHg), a ‘classic’ guideline group (≥140/90 mmHg) and a ‘revised-minus-classic’ group (≥130/80 and <140/90 mmHg). Depressive symptom change was assessed using the Patient Health Questionnaire-9 (PHQ-9). Correlations between changes in PHQ-9 scores and HTN levels by group over a 6- to 18-month observation period were assessed using robust regression analysis. Results There were demographic and clinical differences between groups. A total of 41% of study subjects (1252/3018) had a visit during the follow-up period where additional PHQ-9 and HTN results were available. Depressive symptom change was unrelated to change in blood pressure in the revised and revised-minus-classic groups. The classic HTN group demonstrated a clinically insignificant change in systolic blood pressure for each unit change in PHQ-9 score (β = 0.23, P-value =0.02). Conclusions Although a statistically significant association between reduced HTN levels and improvement in depressive symptoms was demonstrated under classic HTN guidelines, there was no clinically meaningful association between treatment of depression and improved HTN levels under either guideline.

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van Melle, Marije, Samir I. S. Yep Manzano, Hugh Wilson, Willie Hamilton, Fiona M. Walter, and Sarah E. R. Bailey. "Faecal immunochemical test to triage patients with abdominal symptoms for suspected colorectal cancer in primary care: review of international use and guidelines." Family Practice 37, no. 5 (May 7, 2020): 606–15. http://dx.doi.org/10.1093/fampra/cmaa043.

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Abstract Background Recently, faecal immunochemical tests (FITs) have been introduced for investigation of primary care patients with low-risk symptoms of colorectal cancer (CRC), but recommendations vary across the world. This systematic review of clinical practice guidelines aimed to determine how FITs are used in symptomatic primary care patients and the underpinning evidence for these guidelines. Methods MEDLINE, Embase and TRIP databases were systematically searched, from 1 November 2008 to 1 November 2018 for guidelines on the assessment of patients with symptoms suggestive of CRC. Known guideline databases, websites and references of related literature were searched. The following questions were addressed: (i) which countries use FIT for symptomatic primary care patients; (ii) in which populations is FIT used; (iii) what is the cut-off level used for haemoglobin in the faeces (FIT) and (iv) on what evidence are FIT recommendations based. Results The search yielded 2433 publications; 25 covered initial diagnostic assessment of patients with symptoms of CRC in 15 countries (Asia, n = 1; Europe, n = 13; Oceania, n = 4; North America, n = 5; and South America, n = 2). In three countries (Australia, Spain and the UK), FIT was recommended for patients with abdominal symptoms, unexplained weight loss, change in bowel habit or anaemia despite a low level of evidence in the symptomatic primary care patient population. Conclusions Few countries recommend FITs in symptomatic patients in primary care either because of limited evidence or because symptomatic patients are directly referred to secondary care without triage. These results demonstrate a clear need for research on FIT in the symptomatic primary care population.

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Brotons, Carlos, Maciek Godycki-Cwirko, and Mario R. Sammut. "New European guidelines on cardiovascular disease prevention in clinical practice." European Journal of General Practice 9, no. 4 (January 2003): 124–25. http://dx.doi.org/10.3109/13814780309160420.

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Kroes, Robert M., Mattijs E. Numans, Roger H. Jones, Niek J. de Wit, and Theo JM Verheij. "Original Paper: Gastro-oesophageal reflux disease in primary careComparison and evaluation of existing national guidelines and development of uniform European guidelines." European Journal of General Practice 5, no. 3 (January 1999): 88–97. http://dx.doi.org/10.3109/13814789909094270.

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Tompson, Alice, Brian D. Nicholson, Sue Ziebland, Julie Evans, and Clare Bankhead. "Quality improvements of safety-netting guidelines for cancer in UK primary care: insights from a qualitative interview study of GPs." British Journal of General Practice 69, no. 689 (November 4, 2019): e819-e826. http://dx.doi.org/10.3399/bjgp19x706565.

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BackgroundSafety netting is a diagnostic strategy that involves monitoring patients with symptoms possibly indicative of serious illness, such as cancer, until they are resolved. Optimising safety-netting practice in primary care has been proposed to improve quality of care and clinical outcomes. Introducing guidelines is a potential means to achieve this.AimTo seek the insight of frontline GPs regarding proposed safety-netting guidelines for suspected cancer in UK primary care.Design and settingA qualitative interview study with 25 GPs practising in Oxfordshire, UK.MethodTranscripts from semi-structured interviews were analysed thematically by a multidisciplinary research team using a mind-mapping approach.ResultsGPs were supportive of initiatives to optimise safety netting. Guidelines on establishing who has responsibility for follow-up, keeping patient details up to date, and ensuring test result review is conducted by someone with knowledge of cancer guidelines were already being followed. Sharing diagnostic uncertainty and ensuring an up-to-date understanding of guidelines were only partially implemented. Neither informing patients of all (including negative) test results nor ensuring recurrent unexplained symptoms are always flagged and referred were considered feasible. The lack of detail, for example, the expected duration of symptoms, caused some concern. Overall, doubts were expressed about the feasibility of the guidelines given the time, recruitment, and resource challenges faced in UK primary care.ConclusionGPs expressed general support for safety netting, yet were unconvinced that key elements of the guidelines were feasible, especially in the context of pressures on general practice staffing and time.

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Dancy, Luke, Kevin O’Gallagher, Peter Milton, and Dan Sado. "New NICE guidelines for the management of stable angina." British Journal of General Practice 68, no. 669 (March 28, 2018): 202–3. http://dx.doi.org/10.3399/bjgp18x695693.

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Nicoll, Rachel, and Michael Y. Henein. "Hypertension and lifestyle modification: how useful are the guidelines?" British Journal of General Practice 60, no. 581 (December 1, 2010): 879–80. http://dx.doi.org/10.3399/bjgp10x544014.

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van Bruggen, R., K. J. Gorter, R. P. Stolk, R. P. Verhoeven, and G. E. H. M. Rutten. "Implementation of locally adapted guidelines on type 2 diabetes." Family Practice 25, no. 6 (December 1, 2008): 430–37. http://dx.doi.org/10.1093/fampra/cmn045.

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King, Ian, and Paul Nicholson. "Getting a grip on guidelines: occupational contact dermatitis and urticaria." British Journal of General Practice 60, no. 575 (June 1, 2010): 398–99. http://dx.doi.org/10.3399/bjgp10x502074.

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Huddy, Jim. "Writing liver function test guidelines: how hard can it be?" British Journal of General Practice 66, no. 649 (July 28, 2016): 426. http://dx.doi.org/10.3399/bjgp16x686353.

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Lee, Sami, Jong-Sung Kim, Jin-Gyu Jung, Mi-Kyeong Oh, Tae-Heum Chung, and Jihan Kim. "Korean Alcohol Guidelines for Moderate Drinking Based on Facial Flushing." Korean Journal of Family Medicine 40, no. 4 (July 20, 2019): 204–11. http://dx.doi.org/10.4082/kjfm.19.0059.

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Orkin, A. M., W. R. Phillips, and K. C. Stange. "Research Reporting Guidelines and the New Annals Instructions for Authors." Annals of Family Medicine 14, no. 6 (November 1, 2016): 500–501. http://dx.doi.org/10.1370/afm.2008.

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Llor, Carl. "Making guidelines, research and scientific papers as simple as possible." European Journal of General Practice 25, no. 3 (July 3, 2019): 99–100. http://dx.doi.org/10.1080/13814788.2019.1635368.

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FARDY, H. JOHN, and DAVID JEFFS. "Focus Groups: a Method for Developing Consensus Guidelines in General Practice." Family Practice 11, no. 3 (1994): 325–29. http://dx.doi.org/10.1093/fampra/11.3.325.

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Butzlaff, M. "Learning with computerized guidelines in general practice?: A randomized controlled trial." Family Practice 21, no. 2 (April 1, 2004): 183–88. http://dx.doi.org/10.1093/fampra/cmh214.

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Hamoen, E. H., D. F. Reukers, M. E. Numans, J. O. Barentsz, J. A. Witjes, and M. M. Rovers. "Discrepancies between guidelines and clinical practice regarding prostate-specific antigen testing." Family Practice 30, no. 6 (October 9, 2013): 648–54. http://dx.doi.org/10.1093/fampra/cmt045.

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Pescaru, Maria. "Family Education - Guidelines and Actual Practice in Romania." Sociology and Anthropology 5, no. 12 (December 2017): 1023–26. http://dx.doi.org/10.13189/sa.2017.051206.

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Austin, Rebecca Claire, Carriedelle Wilson Fusco, E. Blake Fagan, Evan Drake, Josh Pacious, Hallum Dickens, Shelley L. Galvin, and Courtenay Gilmore Wilson. "Teaching Opioid Tapering Through Guided Instruction." Family Medicine 51, no. 5 (May 7, 2019): 434–37. http://dx.doi.org/10.22454/fammed.2019.502509.

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Background and Objectives: Given the current opioid epidemic, national practice guidelines and many state laws are shifting the treatment paradigm for chronic, noncancer pain to a judicious use of opioids. This has prompted a need to teach family medicine residents how to appropriately taper opioids. We created a multifaceted approach to integrate teaching of opioid tapering into a family medicine curriculum with an emphasis on guided instruction. We assessed the degree to which this curriculum affected guideline-concordant opioid prescribing within the family medicine practice. Methods: A retrospective chart review of 707 patients on chronic opioid therapy (COT) for noncancer pain was conducted before and after the incorporation of a guided instruction experience to the residency curriculum. The primary outcomes included the number of patients on chronic opioids, the average morphine equivalent daily (MED) per patient, the percentage of patients on >50 MED or >90 MED, and the number of patients on concomitant benzodiazepines. Results: Of the original 707 patients, 188 tapered off COT. Of those remaining on COT, the average MED did not change (53.4±76.9 vs 58.5+89.1, P=0.053). The percentage of patients on >50 MED and >90 MED decreased significantly (30.6% vs 25.0%, P=0.001; 19.4% vs 14.0%, P=0.027). The total number of patients on concomitant benzodiazepine decreased from 212 to 131. Conclusions: Providing opportunities for guided instruction with opioid tapering allowed for an increased concordance with national practice guidelines.

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Gruffydd-Jones, Kevin, and Melvyn M. Jones. "NICE guidelines for chronic obstructive pulmonary disease: implications for primary care." British Journal of General Practice 61, no. 583 (February 1, 2011): 91–92. http://dx.doi.org/10.3399/bjgp11x556182.

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Verdijk, Noortje A., Arnold C. Romeijnders, Jos J. Ruskus, Corien van der Sluijs, and Victor J. Pop. "Validation of the Dutch guidelines for dual X-ray absorptiometry measurement." British Journal of General Practice 59, no. 561 (April 1, 2009): 256–60. http://dx.doi.org/10.3399/bjgp09x420338.

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Wilson, Teshina Nicole, Lucia Beck Weiss, Jennie O. Malone, and Katharine Garnier. "Physician knowledge and perception of the need for drug disposal guidelines." Osteopathic Family Physician 3, no. 2 (March 2011): 48–52. http://dx.doi.org/10.1016/j.osfp.2010.07.007.

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Volkov, Ilia, Inna Rudoy, Mochamed Machagna, Inna Glezer, Uri Ganel, Anna Orenshtein, and Yan Press. "What are the recommended guidelines for checking vitamin B12by primary practitioners?" European Journal of General Practice 13, no. 3 (January 2007): 155–56. http://dx.doi.org/10.1080/13814780701471001.

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Stokes, T. "NICE Clinical Guidelines: involving patients, sharing decision-making, considering cost effectiveness." Huisarts en wetenschap 53, no. 1 (January 2010): 20–21. http://dx.doi.org/10.1007/s12445-010-0011-x.

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Kempny, Agnes, and Jamie Martin. "Management of gout and adherence to current guidelines in general practice surgery." British Journal of General Practice 70, suppl 1 (June 2020): bjgp20X711617. http://dx.doi.org/10.3399/bjgp20x711617.

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Abstract:

BackgroundGout is one of the most common inflammatory joint diseases in the UK managed by GPs. The recent (2017) guideline of the British Society for Rheumatology (BSR) changed the recommendation for urate-lowering therapy (ULT) and now advises it after the first episode of gout, whereas it previously recommended after the second one. Moreover, the BSR now also recommends screening and management of risk factors of gout.AimTo audit contemporary management of gout and adherence to the new BSR guideline in a large GP practice.MethodThe audit identified all patients diagnosed with gout between 1 July 2017 and 1 May 2019. Pharmacological gout management, lifestyle advice, and management of risk factors were assessed, including body mass index (BMI), systemic blood pressure (BP), and HbA1c.ResultsThe audit included 104 patients, 26.9% female, mean age 63.8 years at the age of diagnosis. Uric acid was raised in all patients (mean 469 um/L). Most patients (68%) had abnormal BMI (mean 30.4), whereas BP, cholesterol, and HbA1C were normal in the majority of patients (in 78%, 75%, and 90%, respectively); however, all of these parameters were normal in just 17% of patients. Lifestyle advice was given to 46 (44.2%) patients while allopurinol was prescribed, and overall in 21 (20.2%) patients. More patients were managed with colchicine (40.2%) and naproxen (56.7%).ConclusionMost patients diagnosed with a first gout attack have risk factors of gout and require their management. Overall, allopurinol is prescribed in a fifth of patients, which may be related to patients’ preferences, strict adherence to lifestyle modification only, or presence of contraindications to allopurinol. This requires, however, further assessment.

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