Stefanie Vaccher1, Diluk R W Kannangara1, Melissa T Baysari1, Jennifer Reath1, Nicholas Zwar1, Kenneth M Williams1, Richard O Day2. 1. From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW. 2. From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW. r.day@unsw.edu.au.
Abstract
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.
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.
Authors: Matthew J Coleshill; Eindra Aung; Jane E Carland; Kate Faasse; Sophie Stocker; Richard O Day Journal: Ther Innov Regul Sci Date: 2020-07-13 Impact factor: 1.778
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Authors: David Bursill; William J Taylor; Robert Terkeltaub; Abhishek Abhishek; Alexander K So; Ana Beatriz Vargas-Santos; Angelo Lino Gaffo; Ann Rosenthal; Anne-Kathrin Tausche; Anthony Reginato; Bernhard Manger; Carlo Sciré; Carlos Pineda; Caroline van Durme; Ching-Tsai Lin; Congcong Yin; Daniel Arthur Albert; Edyta Biernat-Kaluza; Edward Roddy; Eliseo Pascual; Fabio Becce; Fernando Perez-Ruiz; Francisca Sivera; Frédéric Lioté; Georg Schett; George Nuki; Georgios Filippou; Geraldine McCarthy; Geraldo da Rocha Castelar Pinheiro; Hang-Korng Ea; Helena De Almeida Tupinambá; Hisashi Yamanaka; Hyon K Choi; James Mackay; James R ODell; Janitzia Vázquez Mellado; Jasvinder A Singh; John D Fitzgerald; Lennart T H Jacobsson; Leo Joosten; Leslie R Harrold; Lisa Stamp; Mariano Andrés; Marwin Gutierrez; Masanari Kuwabara; Mats Dehlin; Matthijs Janssen; Michael Doherty; Michael S Hershfield; Michael Pillinger; N Lawrence Edwards; Naomi Schlesinger; Nitin Kumar; Ole Slot; Sebastien Ottaviani; Pascal Richette; Paul A MacMullan; Peter T Chapman; Peter E Lipsky; Philip Robinson; Puja P Khanna; Rada N Gancheva; Rebecca Grainger; Richard J Johnson; Ritch Te Kampe; Robert T Keenan; Sara K Tedeschi; Seoyoung Kim; Sung Jae Choi; Theodore R Fields; Thomas Bardin; Till Uhlig; Tim Jansen; Tony Merriman; Tristan Pascart; Tuhina Neogi; Viola Klück; Worawit Louthrenoo; Nicola Dalbeth Journal: Ann Rheum Dis Date: 2019-09-09 Impact factor: 19.103
Authors: Richard O Day; Lauren J Frensham; Amy D Nguyen; Melissa T Baysari; Eindra Aung; Annie Y S Lau; Nicholas Zwar; Jennifer Reath; Tracey Laba; Ling Li; Andrew McLachlan; William B Runciman; Rachelle Buchbinder; Robyn Clay-Williams; Enrico Coiera; Jeffrey Braithwaite; H Patrick McNeil; David J Hunter; Kevin D Pile; Ian Portek; Kenneth Mapson WIlliams; Johanna I Westbrook Journal: BMJ Open Date: 2017-10-16 Impact factor: 2.692