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Dissertation/Thesis Abstract

Improving the Evidence Based Diagnosis of Gout in the Primary Care Setting
by Miller, Kelly, D.N.P., State University of New York at Binghamton, 2017, 111; 10281524
Abstract (Summary)

Although gout is the most prevalent form of inflammatory arthritis, its diagnosis can be complex. To meet the gold standard for diagnosis, providers need to perform a joint aspiration and identify the presence of monosodium urate crystals (MSU) in the synovial fluid or from tophi, a challenging skill in the primary care setting. In its absence, patients have to meet several criteria before a diagnosis can be made. Not surprisingly, gout has been inconsistently diagnosed by Primary Care Providers (PCPs). Thus in 2015, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) worked collaboratively to develop a new set of clinical criteria for the diagnosis of gout.

For this Doctor of Nursing Practice (DNP) Capstone Project, a review of the literature was conducted using the Chronic Care Model (CCM) as a guide to examine the evidence regarding the use of clinical guidelines for the diagnosis of gout in the primary care setting. Using a pretest-posttest reflexive control design, chart abstraction was performed and, subsequently, an educational session was conducted to see if a short learning lunch would increase PCP knowledge and documentation in the medical record related to use of the 2015 ACR/EULAR diagnostic criteria.

A total of 36 PCPs from six different primary care settings participated. Chart abstraction revealed that only 31 out of the 54 charts (57%) had adequate documentation to support a diagnosis of gout. A statistically significant improvement in knowledge was demonstrated for several domains of the diagnostic criteria at the posttest. Results from this project indicated that a short learning lunch was effective for increasing PCP knowledge of the 2015 ACR/EULAR gout classification criteria. Through clinical support, easier access to updated evidence based clinical guidelines, and continuing education, PCPs acquired new knowledge and skills essential for providing evidence-based, quality care to their patients.

Indexing (document details)
Advisor: Johnston, Yvonne A.
Commitee: Fitzgerald, Kathleen, Flanagan, Nina
School: State University of New York at Binghamton
Department: Nursing
School Location: United States -- New York
Source: DAI-B 78/12(E), Dissertation Abstracts International
Subjects: Nursing, Health education
Keywords: Chart review, Clinical diagnosis, Evidence based practice, Gout, Primary care, Provider education
Publication Number: 10281524
ISBN: 978-0-355-08341-5
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