Evaluation of supported self-management in gout (GoutSMART): a randomised controlled feasibility trial

Riches, Philip; Alexander, Debbie; Burden, Andrea M.; Kuske, Barbara; Krause, Amrey

doi:10.1016/s2665-9913(22)00062-5

Cited by 15 publications

(20 citation statements)

References 19 publications

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“…The value of at-home POC measurements has previously been demonstrated by fecal calprotectin in patients with inflammatory bowel disease. Recently, Riches et al demonstrated that usage of an app and urate self-testing substantially improved attainment of urate targets compared with usual care [39]. We believe that adding POC CRP tests to remote RA monitoring may add an important objective cornerstone.…”

Section: Discussionmentioning

confidence: 83%

Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study

Stenzel

Hadaschik

May

et al. 2022

BMC Health Serv Res

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Objective A steadily increasing demand and decreasing number of rheumatologists push current rheumatology care to its limits. Long travel times and poor accessibility of rheumatologists present particular challenges for patients. Need-adapted, digitally supported, patient-centered and flexible models of care could contribute to maintaining high-quality patient care. This qualitative study was embedded in a randomized controlled trial (TELERA) investigating a new model of care consisting of the use of a medical app for ePRO (electronic patient-reported outcomes), a self-administered CRP (C-reactive protein) test, and joint self-examination in rheumatoid arthritis (RA) patients. The qualitative study aimed to explore experiences of RA patients and rheumatology staff regarding (1) current care and (2) the new care model. Methods The study included qualitative interviews with RA patients (n = 15), a focus group with patient representatives (n = 1), rheumatology nurses (n = 2), ambulatory rheumatologists (n = 2) and hospital-based rheumatologists (n = 3). Data was analyzed by qualitative content analysis. Results Participants described current follow-up care as burdensome. Patients in remission have to travel long distances. Despite pre-scheduled visits physicians lack questionnaire results and laboratory results to make informed shared decisions during face-to-face visits. Patients reported that using all study components (medical app for ePRO, self-performed CRP test and joint self-examination) was easy and helped them to better assess their disease condition. Parts of the validated questionnaire used in the trial (routine assessment of patient index data 3; RAPID3) seemed outdated or not clear enough for many patients. Patients wanted to be automatically contacted in case of abnormalities or at least have an app feature to request a call-back or chat. Financial and psychological barriers were identified among rheumatologists preventing them to stop automatically scheduling new appointments for patients in remission. Rheumatology nurses pointed to the potential lack of personal contact, which may limit the holistic care of RA-patients. Conclusion The new care model enables more patient autonomy, allowing patients more control and flexibility at the same time. All components were well accepted and easy to carry out for patients. To ensure success, the model needs to be more responsive and allow seamless integration of education material. Trial registration The study was prospectively registered on 2021/04/09 at the German Registry for Clinical Trials (DRKS00024928).

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Section: Discussionmentioning

confidence: 83%

Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study

Stenzel

Hadaschik

May

et al. 2022

BMC Health Serv Res

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“…While this approach is new to rheumatology, Pedersen and colleagues reported that self-monitoring (weekly questionnaire completion + fecal calprotectin test) using a web application helped to personalize treatment for patients suffering from ulcerative colitis [ 25 ] and Crohn’s disease [ 26 ]. In a recent feasibility trial patient self-sampling helped to substantially improve urate levels in patients with gout [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy and tolerability of self-sampling of capillary blood for analysis of inflammation and autoantibodies in rheumatoid arthritis patients—results from a randomized controlled trial

et al. 2022

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Background Rheumatoid arthritis (RA) requires early diagnosis and tight surveillance of disease activity. Remote self-collection of blood for the analysis of inflammation markers and autoantibodies could improve the monitoring of RA and facilitate the identification of individuals at-risk for RA. Objective Randomized, controlled trial to evaluate the accuracy, feasibility, and acceptability of an upper arm self-sampling device (UA) and finger prick-test (FP) to measure capillary blood from RA patients for C-reactive protein (CRP) levels and the presence of IgM rheumatoid factor (RF IgM) and anti-cyclic citrullinated protein antibodies (anti-CCP IgG). Methods RA patients were randomly assigned in a 1:1 ratio to self-collection of capillary blood via UA or FP. Venous blood sampling (VBS) was performed as a gold standard in both groups to assess the concordance of CRP levels as well as RF IgM and CCP IgG. General acceptability and pain during sampling were measured and compared between UA, FP, and VBS. The number of attempts for successful sampling, requests for assistance, volume, and duration of sample collection were also assessed. Results Fifty seropositive RA patients were included. 49/50 (98%) patients were able to successfully collect capillary blood. The overall agreement between capillary and venous analyses for CRP (0.992), CCP IgG (0.984), and RF IgM (0.994) were good. In both groups, 4/25 (16%) needed a second attempt and 8/25 (32%) in the UA and 7/25 (28%) in the FP group requested assistance. Mean pain scores for capillary self-sampling (1.7/10 ± 1.1 (UA) and 1.9/10 ± 1.9 (FP)) were significantly lower on a numeric rating scale compared to venous blood collection (UA: 2.8/10 ± 1.7; FP: 2.1 ± 2.0) (p=0.003). UA patients were more likely to promote the use of capillary blood sampling (net promoter score: +28% vs. −20% for FP) and were more willing to perform blood collection at home (60% vs. 32% for FP). Conclusions These data show that self-sampling is accurate and feasible within one attempt by the majority of patients without assistance, allowing tight monitoring of RA disease activity as well as identifying individuals at-risk for RA. RA patients seem to prefer upper arm-based self-sampling to traditional finger pricking. Trial registration DRKS.de Identifier: DRKS00023526. Registered on November 6, 2020.

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“…Further, patient-led selfmonitoring of urate improves urate target attainment, but the impact on adherence is unknown. 37 The impact of point-of-care testing, including urate concentration self-monitoring, on long-term adherence to allopurinol requires further examination. Furthermore, an indepth assessment and understanding of how self-monitoring urate concentration influences adherence behaviour using appropriate approaches 77 are important future research considerations.…”

Section: Strategies To Improve Adherence To Allopurinolmentioning

confidence: 99%

“…Existing interventions to improve adherence to allopurinol are predominantly nurse-or pharmacist-led, including a shared-care component 27,[29][30][31][32][34][35][36][37] involving gout educational and behavioural strategies. 36,[38][39][40][41] Interventions are infrequently patient-led, and improvements to adherence and/or overall gout outcomes are generally modest and variable, 42,43 with few exceptions.…”

Section: Introductionmentioning

confidence: 99%

Optimizing adherence to allopurinol for gout: patients' perspectives

Spragg

Michael

Aslani

et al. 2023

Brit J Clinical Pharma

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patient perspectives on strategies to improve adherence, including self-monitoring urate concentration.Methods: Semi-structured interviews were conducted with 26 people with gout, previously or currently taking allopurinol. De-identified verbatim transcripts were thematically analysed using an inductive and deductive approach.Results: Facilitators of adherence during allopurinol initiation were motivation to prevent gout flares and trust in the advice of their healthcare professionals (HCPs). Reluctance to commence long-term medication was a barrier to allopurinol initiation.Believing in the effectiveness and necessity of allopurinol and reminder systems were facilitators of implementation. Barriers to implementation included forgetfulness, gout flares and limited feedback on allopurinol's effectiveness. Patients discontinued therapy when allopurinol was perceived as ineffective or unnecessary. Discontinuation coincided with patients experiencing gout flares while adhering to allopurinol and receiving suboptimal advice about gout management. Patients identified receiving accurate advice from HCPs and regular urate monitoring for feedback on allopurinol's effectiveness as potential strategies to improve adherence. Perceived benefits of selfmonitoring urate as a strategy to promote adherence included the ability to selfmanage gout and make informed decisions about allopurinol therapy with their HCP. Conclusion:Patient perceptions of the effectiveness and necessity of allopurinol influenced intentional adherence during medication initiation, implementation and discontinuation. Strategies that inform patients of their urate control and provide accurate medical advice have the potential to improve adherence to allopurinol.The authors confirm that the Principal Investigator for this article is Dr Sophie Stocker. As this paper was a qualitative analysis of semi-structured interviews, the Principal Investigator did not require clinical responsibility for the study subjects.

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Evaluation of supported self-management in gout (GoutSMART): a randomised controlled feasibility trial

Cited by 15 publications

References 19 publications

Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study

Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study

Accuracy and tolerability of self-sampling of capillary blood for analysis of inflammation and autoantibodies in rheumatoid arthritis patients—results from a randomized controlled trial

Optimizing adherence to allopurinol for gout: patients' perspectives

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