Abstract
Background:Uric acid lowering therapy (ULT) can be effective in gout if taken correctly (1), but non-adherence is a known problem (2). Although patients’ adherence barriers regarding ULT, such as lack of knowledge on disease and therapy, and beliefs, have been widely studied (3), less is known physicians’ beliefs.Objectives:To investigate the physicians’ beliefs on ULT treatment in both primary and secondary care in the Netherlands.Methods:Cross-sectional study among all rheumatologists of the Sint Maartenskliniek and to all General Practitioners (GPs) of 17 practices, participating in the practice-based research network Family Medicine Network Nijmegen, Netherlands. All participants filled out the beliefs about medication questionnaire (BMQ), adjusted for physicians; in addition data were collected on physician characteristics including working experience in total and gout consultations. The BMQ consists of two parts, a specific part with 10 questions about beliefs on necessity (N=5) and concerns (N=5) regarding ULT and a general part with 8 questions about beliefs on harms (N=4) and overuse (N=4) regarding medication in general. Each question is scored on a Likert-scale from 1-5, a higher score corresponds to higher beliefs on that category. Sum scores for all four categories were calculated. With the total scores on the specific BMQ including necessity and concerns beliefs, physicians were classified in four different categories (Table 1)(4).Results:In total 112 physicians received the questionnaire, 28 of 37 rheumatologists (76%) and 45 of 75 GPs (60%) responded. Rheumatologists had less years of experience than GPs (median 8.5 years (IQR 3 – 14) versus (vs) 13 years (IQR 8-20)) and less hours of patient contact per week (15 hours (IQR 8.5 – 20) vs 24 hours (IQR 20 – 30)). Rheumatologists reported more consultations for gout per week than GPs: median 4 (IQR 1 – 6.6) vs 1 (IQR 0.2– 1).Rheumatologists scored higher on the BMQ necessity scale, 17.5 (95% CI 16.6 – 18.5) compared to GPs 16.1 (95% CI 15.1 – 17.1). GPs scored higher on BMQ concern scale, 12.1 (95% CI 11.4 – 12.7) compared to rheumatologists, 10.4 (95% CI 9.7 – 11.2). On medication in general, GPs scored higher on both overuse and harms scales compared to rheumatologists, 11.3 (95% CI 10.7 – 12) versus 9.9 (95% CI 9 – 10.7)and 8.3 (95% CI 7.9 – 8.7) vs 7.1 (95% CI 6.5 – 7.7), respectively. Table 1 shows classification according to the BMQ specific for both groups.Table 1.Classification based on the adapted BMQRheumatologists (N=28)GPs (N=45)Acceptant (%)19 (67.9)16 (35.6)Ambivalent (%)08 (17.8)Sceptic (%)1 (3.6)5 (11.1)Indifferent (%)8 (28.6)16 (35.6)Conclusion:For the majority of rheumatologist the necessity beliefs outweighs concern beliefs towards the use of ULT outweighs concern beliefs. GPs show a more heterogenic profile, including acceptant, indifferent and ambivalent beliefs towards ULT use. GPs also show higher harm and overuse concerns regarding medication in general. Next step is to investigate possible associations with actual ULT use and disease outcome.
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