Diagnosis and management of gout by clinicians in Nepal: a web-based survey
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Rheumatology International https://doi.org/10.1007/s00296-020-04712-3
INTERNATIONAL
OBSERVATIONAL RESEARCH
Diagnosis and management of gout by clinicians in Nepal: a web‑based survey Binit Vaidya1 · Kalpana Pudasaini1 · Rikesh Baral1 · Shweta Nakarmi1 Received: 17 August 2020 / Accepted: 23 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Patients with gout in Nepal are usually attended by medical graduates, family medicine, internists, and orthopedic surgeons. The study aimed to evaluate knowledge, attitude, and practice (KAP) of point-of-care clinicians of Nepal regarding diagnosis and management of gout and assess the quality of treatment provided to the patients. A web-based descriptive, cross-sectional study was conducted among doctors managing gout patients. The questionnaire comprises 38 multiple choice questions; 9 questions for demographic data, 8, 11, and 10 questions each for knowledge, attitude, and practice, respectively. A pilot study was conducted to observe comprehensibility of the questionnaire before subjecting it to the participants. Ethical approval was obtained from review committee of National Center for Rheumatic diseases, Nepal. Simple descriptive statistics was used to describe the correct responses. Among 1200 clinicians invited, 32% (380) participated in the survey. Maximum respondents were of age group 25–45 years (82%) with majority being internists (43%). Although only 32% understood that the disease is not curable, knowledge regarding disease was acceptable in majority (60–90%). Around 83% denied attending any gout-related seminars and 34% denied being updated with the recent guidelines. The majority of postgraduates (72%) managed the cases themselves. Although there was acceptable practice accuracy on use of therapy for acute attacks (75%), target urate levels (57%), and use of urate-lowering agents (92%), they lacked in adequate screening of co-morbidities and initiation of long-term treatment. The point-of-care clinicians have adequate knowledge to diagnose and treat acute events. However, there is poor reflection in practice and frequent update of treatment guidelines is warranted. Keywords Gout · Survey · Knowledge · Attitude · Practice Abbreviations KAP Knowledge, attitude, and practice MSU Monosodium urate USA United States of America HTN Hypertension CKD Chronic kidney disease ACR American College of Rheumatology EULAR European league against rheumatism NRA Nepal Rheumatology Association * Binit Vaidya [email protected] Kalpana Pudasaini [email protected] Rikesh Baral [email protected] Shweta Nakarmi [email protected] 1
National Center for Rheumatic Diseases (NCRD), Ratopul, Kathmandu, Nepal
SIMON Society of internal medicine of Nepal MBBS Bachelors in Medicine and Bachelors in Surgery MCQ Multiple choice question CHD Coronary heart disease LMIC Low-middle income country ULT Urate lowering therapy CME Continued medical education
Introduction Gout is an inflammatory arthritis resulti
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