Bridging the evidence-practice gap for people with gout

Abstract

Gout is a common and disabling form of arthritis. Despite widely available, highly effective, urate-lowering therapies, such as allopurinol, studies continue to demonstrate poor care for individuals with gout in healthcare systems worldwide. In this commentary, we highlight strategies that can be utilised to overcome real-world barriers to optimal gout care, including allied health professional input, patient and clinician education, self-management strategies, and electronic health record solutions.

Keywords

Gout / urate-lowering therapy / allopurinol / febuxostat / guidelines

References

[1] Russell MD, Massey J, Roddy E, MacKenna B, Bacon S, Goldacre B, et al. Gout incidence and management during the COVID-19 pandemic in England, UK: a nationwide observational study using OpenSAFELY. Lancet Rheumatol. 2023; 5: e622-32.

[2] Singh G, Lingala B, Mithal A. Gout and hyperuricaemia in the USA: prevalence and trends. Rheumatology (Oxford). 2019; 58: 2177-80.

[3] Russell MD, Rutherford AI, Ellis B, Norton S, Douiri A, Gulliford MC, et al. Management of gout following 2016/2017 European (EULAR) and British (BSR) guidelines: An interrupted time-series analysis in the United Kingdom. Lancet Reg Health Eur. 2022; 18: 100416.

[4] Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015; 74: 661-7.

[5] Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020; 16: 380-90.

[6] Gill I, Dalbeth N, ’Ofanoa M, Goodyear-Smith F. Interventions to improve uptake of urate-lowering therapy in patients with gout: a systematic review. BJGP Open. 2020; 4: bjgpopen20X101051.

[7] Doherty M, Jenkins W, Richardson H, Sarmanova A, Abhishek A, Ashton D, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet. 2018; 392: 1403-12.

[8] What is the clinical and cost-effectiveness of using a goal-directed allopurinol-based treat-to-target protocol in people with recurrent gout attacks? [Internet]. National Institute for Health and Care Research; [cited 2024 Jul 17]. Available from: https://fundingawards.nihr.ac.uk/award/17/82/02

[9] Riches PL, Alexander D, Hauser B, Kuske B, Krause A. Evaluation of supported self-management in gout (GoutSMART): a randomised controlled feasibility trial. Lancet Rheumatol. 2022; 4: e320-8.

[10] Institute for Safe Medication Practices. Medication Error Prevention “Toolbox” [Internet]. Pennsylvania: ECRI; c2024 [cited 2024 Jul 17]. Available from: https://www.ismp.org/resources/medication-error-prevention-toolbox

[11] Kempegowda P, Chandan JS, Hutton R, Brown L, Madden W, Webb J, et al. Focused educational intervention improves but may not sustain knowledge regarding falls management. BMJ Open Qual. 2018; 7: e000222.

[12] Soong C, Shojania KG. Education as a low-value improvement intervention: often necessary but rarely sufficient. BMJ Qual Saf. 2020; 29: 353-7.

[13] Cebul RD, Love TE, Jain AK, Hebert CJ. Electronic health records and quality of diabetes care. N Engl J Med. 2011; 365: 825-33.

[14] Hunt JS, Siemienczuk J, Gillanders W, LeBlanc BH, Rozenfeld Y, Bonin K, et al. The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study. Inform Prim Care. 2009; 17: 165-74.

[15] Stamp LK, Chapman P, Hudson B, Frampton C, Hamilton G, Judd A. The challenges of managing gout in primary care: Results of a best-practice audit. Aust J Gen Pract. 2019; 48: 631-7.

[16] Spencer K, Carr A, Doherty M. Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis. 2012; 71: 1490-5.

[17] Gout: diagnosis and management. London: National Institute for Health and Care Excellence (NICE); 2022.

[18] Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013; 8: e80633.

[19] Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999; 47: 555-67.

[20] Elfishawi MM, Zleik N, Kvrgic Z, Michet CJ Jr, Crowson CS, Matteson EL, et al. The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years. J Rheumatol. 2018; 45: 574-9.

[21] Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS, et al. Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford). 2010; 49: 141-6.

[22] Fisher MC, Rai SK, Lu N, Zhang Y, Choi HK. The unclosing premature mortality gap in gout: a general population-based study. Ann Rheum Dis. 2017; 76: 1289-94.