Background/Purpose:

Gout is a chronic condition with a considerable effect on patient health and quality of life. Despite the availability of multiple pharmacologic treatments and evidence-based management guidelines, treatment targets are often not achieved in patients with gout. A study was conducted to determine if online, case-based intervention could improve clinical decisions made by rheumatologists and PCPs regarding the management of patients with gout.

Methods: Educational design included 2 online, interactive, patient cases presented using a “test, then teach” approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design with 3 case-based questions and 1 confidence question, in which each individual served as his/her own control. McNemar’s chi-squared test assessed differences from pre- to post-assessment. P values <.05 are statistically significant. Cramer’s V was used to calculate the effect size (<0.05 no effect; 0.06-0.15 noticeable effect; 0.16-0.26 considerable effect; >0.26 extensive effect). The activity launched 12/26/2017, with data collected through 1/18/2018.

Results:

The analysis set consisted of responses from rheumatologists (n=73) and primary care physicians (PCPs, n=1053) who answered all assessment questions during the study period. Analysis of pre- vs post-intervention responses by demonstrated a significant improvement in overall competence of with considerable educational impact (rheumatologists: V = .276, P<.0001. PCPs: V = .358, P<.0001).

Average correct responses increase from 68% pre to 90% post education for rheumatologists, and 41% pre to 76% post for PCPs. Specific areas of improvement in clinical decisions include:

• Addition of allopurinol to colchicine in a patient with serum urate level of 9.2 mg/d
• Treatment with fixed-dose lesinurad/allopurinol combination therapy in a patient with adherence issues while maintaining target urate levels
• Switching from allopurinol to febuxostat in a patient with uncontrolled serum urate levels and hypersensitivity to allopurinol based on HLA-B*5801 positivity

Post-education, 18% of rheumatologists and 36% of PCPs were more confident in using a treat-to-target approach when prescribing urate-lowering therapy in gout.

Conclusion:

This study demonstrated the success of online, interactive, case-based education on improving the evidence-based clinical decisions and confidence of rheumatologists and PCPs in selecting appropriate treatment for patients with gout using a treat-to-target approach.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-clinical-decisions-for-gout-management-effect-of-online-case-based-education/