FRI0226 Assessment of therapy adherence and treatment results in gout patients who attended schools for patients and in those who did not

Abstract

BackgroundGout is a poorly controlled disease despite the availability of effective treatment methods. One of the main reasons for its poor controll is patients’ low adherence to treatment, including due to insufficient knowledge of treatment principles.ObjectivesTo assess adherence to therapy and results of treatment in gout patients who attended schools for patients and in those who did not.MethodsAll patients with crystal-verified gout were interviewed and invited to attend School for gout pts. Totally 301 pts with gout were observed, 36 (10%) females and 264 (90%) males, mean age 54.5±12,7 y., mean disease duration 9.02±1,12 y., with the gout diagnosis verified at average 48.71[12;60 months after the onset, the target UA level <360 µmol/l initially was in 72 pts (24%).All patients were divided into 3 groups: Group 1 included 111 (36%) patients who refused to attend the school, Group 2 included 90 (30%) patients who consented but failed to come, Group 3 consisted of 100 (34%) patients who attended the School (- 100 (34%)).The data from the questionnaires were used for baseline and on-treatment assessments of the following: patient‘s attitude to the disease, patient’s compliance to treatment, satisfaction with quality of life, the fact of taking urate-lowering therapy, UA level control, achievement of the UA level of <360 µmol/l.ResultsIn all 3 groups, after the visit to the doctor, the number of the patients taking urate-lowering therapy who reached the target level of uric acid, significantly increased, the maximum values were noted in the group who attended the School for gout pts. The UA target level achievement results in Group 2, of those who agreed to attend the School but never did for various reasons, were better than in Group 1 and comparable to that in Group 3. Table 1 presents the results of questionnaire survey at baseline and after one year.Better adherence to treatment was noted in patients with poorer quality of life and a rational attitude toward their disease. The patients who report satisfaction with quality of life often decided to refuse to take their medications, visited the doctor less often and more seldom achieved the UA target level.Abstract FRI0226 – Table 1Parameters at baseline and after one yearparametersGroup 1 (patients who refused to attend the school), n=111Group 2 (patients who consented but failed to come), n=90Group 3 (patients who attended the school), n=100 baselineafter 1 yearbaselineafter 1 yearbaselineafter 1 year Did not take urate lowering therapy, n (%)86 (79%)38 * (35%)55 (62%)12 (12%)56 (56%)8 (8%)Monitored the level of UA, n (%)62 (56%)76 * (69%)68 (75%)72 (80%)62 (62%)90 (92%)Achieved the target UA level<360 µmol/l, n (%)8 (33%)56* (51%)14 (15%)62 (69%)13 (13%)87 (87%)Satisfied with the quality of life, n (%)84 (67%)85 (77%)42 (47%)75 (83%)62 (62%)95 (95%)Not satisfied with the quality of life, n (%)26 (33%)5 (5%)48 (53%)3 (4%)38 (38%)3 (3%)»*<0,05 between the baseline and one-yearConclusionsPatients’ attendance of the School for gout pts increases their adherence...

Review of gout clinic in a tertiary hospital setting

“…1 Gout is associated with significant disability, and consistent with an increase in prevalence, the World Health Organization 2010 Global Burden of Disease study demonstrated a doubling of disabilityadjusted life years for gout between 1990 and 2010. 4,5 The Queen Elizabeth Hospital (TQEH), located in the western suburbs of Adelaide, has a monthly gout clinic, which is run by three medical officers (rheumatologist, rheumatology registrar and basic physician trainee). This is usually due to inadequate education of the patient and/or their primary care physician regarding optimal gout treatment resulting in inappropriate ULT dosing, failure to treat to target serum urate, failure to prescribe flare prophylaxis, cessation of ULT during gout flares or because of worsening renal failure, and failure to appreciate that gout is a chronic condition requiring on-going medication.…”

“…3 Several studies have demonstrated that regular follow-up for the management of gout leads to better disease control. 4,5 The Queen Elizabeth Hospital (TQEH), located in the western suburbs of Adelaide, has a monthly gout clinic, which is run by three medical officers (rheumatologist, rheumatology registrar and basic physician trainee). The treatment protocol follows current consensus guidelines 6-8 with a treat-to-target approach, which aims for a sustained target serum urate level of <0.36 mmol/L, or < 0.30 mmol/L for patients with complex disease and/or tophi.…”

Factors Affecting Patient Adherence to Pharmacological Therapy in Gout Arthritis and Hyperuricemia

“…19,20 Knowledge was an essential factor because gout arthritis was a disease that is poorly controlled even though the available therapies are effective. 30 An experimental study found that patients who attended the "school for gout" had more knowledge, thereby increasing therapy adherence and the patient's quality of life. Regarding the explanation in the correlation of patient attitudes and behavior towards adherence to previous therapy, the correlation of knowledge has been investigated for several similar pharmacological therapies.…”

Commentaries on the updated American College of Rheumatology guidelines for the management of gout. Urate-lowering drugs (Part 1)

“…Наш опыт обучающих мероприятий для пациентов позволяет согласиться, что подробная информация о подагре, в том числе о принципах ее лечения и самоконтроля, которую сообщает ревматолог, улучшает приверженность терапии и возможность достижения ее целей [39]. Аналогичные выводы были сделаны в ряде работ [40][41][42], в которых обучение пациентов проводилось медицинскими сестрами или фармакологами.…”

“…Аналогичные выводы были сделаны в ряде работ [40][41][42], в которых обучение пациентов проводилось медицинскими сестрами или фармакологами. Тем не менее метод получения пациентом информации имеет второстепенное значение [39], что подчеркивает условность рекомендации.…”