RT Journal Article
SR Electronic
T1 Barriers to Care in Gout: From Prescriber to Patient
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 144
OP 149
DO 10.3899/jrheum.150607
VO 43
IS 1
A1 Stefanie Vaccher
A1 Diluk R.W. Kannangara
A1 Melissa T. Baysari
A1 Jennifer Reath
A1 Nicholas Zwar
A1 Kenneth M. Williams
A1 Richard O. Day
YR 2016
UL http://www.jrheum.org/content/43/1/144.abstract
AB Objective. To explore the understanding of gout and its management by patients and general practitioners (GP), and to identify barriers to optimal gout care.Methods. Semistructured interviews were conducted with 15 GP and 22 patients in Sydney, Australia. Discussions were focused on medication adherence, experiences with gout, and education and perceptions around interventions for gout. Interviews were audio recorded, transcribed verbatim, and analyzed for themes using an analytical framework.Results. Adherence to urate-lowering medications was identified as problematic by GP, but less so by patients with gout. However, patients had little appreciation of the risk of acute attacks related to variable adherence. Patients felt stigmatized that their gout diagnosis was predominantly related to perceptions that alcohol and dietary excess were causal. Patients felt they did not have enough education about gout and how to manage it. A manifestation of this was that uric acid concentrations were infrequently measured. GP were concerned that they did not know enough about managing gout and most were not familiar with current guidelines for management. For example and importantly, the strategies for reducing the risk of acute attacks when commencing urate-lowering therapy (ULT) were not well appreciated by GP or patients.Conclusion. Patients and GP wished to know more about gout and its management. Greater success in establishing and maintaining ULT will require further and better education to substantially benefit patients. Also, given the prevalence, and personal and societal significance of gout, innovative approaches to transforming the management of this eminently treatable disease are needed.