Beliefs of Rheumatologists and General Practitioners on Urate Lowering Therapy: a Cross-Sectional Study

Lay Summary Gout is a painful disease that seems easy to treat. However, in real life, many patients do not reach their treatment goal with urate-lowering therapy (ULT). We wanted to study the beliefs of rheumatologists and general practitioners (GPs) regarding ULT. These beliefs might influence how rheumatologists and GPs treat their patients and how patients think about ULT. We also wanted to know whether these beliefs affected patients' beliefs or the outcome of their disease. Questionnaires about beliefs were sent to rheumatologists, GPs and their patients. Information on the treatment of gout was collected from the electronic patient records. The results show that rheumatologists scored higher on necessity beliefs and lower on concern beliefs compared with GPs. No relationship was found between the beliefs of rheumatologists and GPs and the dosage of ULT medication they prescribed, the serum urate, the number of gout attacks or their patients' beliefs. This means that the role of beliefs of rheumatologists and GPs is limited in how they treat their gout patients. Further qualitative research can provide further information. Objective To describe beliefs of physicians and patients in primary and secondary care about urate-lowering therapy (ULT), to examine differences in physicians' medication beliefs and to examine the association of physicians' medication beliefs with the prescribed dosage of ULT, gout outcomes and patients' medication beliefs. Methods We conducted a cross-sectional study among rheumatologists and general practitioners (GPs) and their patients using ULT in The Netherlands. All participants filled out the Beliefs About Medication Questionnaire (BMQ). Demographics of physicians were collected through questionnaires. Patient and disease characteristics were collected through questionnaires and electronic medical records. Differences between rheumatologists and GPs in the BMQ subscales Necessity and Concern and the necessity-concern difference (NCD) score were analysed by two-sample t-tests. Multilevel analyses were performed to examine the association of physicians' BMQ scores with the prescribed dosage of ULT, gout outcomes (number of gout flares, serum urate) and patients' BMQ scores. Results A total of 28 rheumatologists, 443 rheumatology patients, 45 GPs and 294 GP patients were included. The mean NCD scores were 7.1 (s.d. 3.6), 4.0 (s.d. 4.0), and 4.2 (s.d. 5.0) for rheumatologists, GPs and patients, respectively. Rheumatologists scored higher on necessity beliefs [mean difference 1.4 (95% CI 0.0, 2.8)] and lower on concern beliefs [mean difference -1.7 (95% CI -2.7, -0.7)] compared with GPs. No associations between physicians' beliefs and prescribed dosage of ULT, gout outcomes or patients' beliefs were found. Conclusion Rheumatologists had higher necessity and lower ULT concern beliefs compared with GPs and patients. Physicians' beliefs were not related to prescribed ULT dosage and patient outcomes. The role of physicians' beliefs in gout management in patients using ULT seems limited. Future qualitative research can provide more insights into physicians' views of gout management.