Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies

Abstract

Our systematic review of worldwide literature consistently identified gaps in gout knowledge among providers, which is likely to contribute to patients' lack of appropriate education about the fundamental causes of and essential treatment approaches for gout. Furthermore, system barriers among providers and day-to-day challenges of taking long-term medications among patients are considerable. These factors provide key targets to improve the widespread suboptimal gout care.

Review of gout clinic in a tertiary hospital setting

“…10 This has been attributed to population longevity as well as lifestyle changes. 3 Patients seen in our gout clinic had been suffering from this disease for decades. 3 Patients seen in our gout clinic had been suffering from this disease for decades.…”

“…The prevalence of gout has been steadily rising since the 1960s and a recent South Australian study estimated a prevalence of 5.2% in the community, with a 16.6% prevalence of hyperuricemia. 3 Several studies have demonstrated that regular follow-up for the management of gout leads to better disease control. 2 Although ULT is an effective treatment for gout management, its utilisation is suboptimal in practice.…”

Time to recognise gout as a chronic disease

“…Many people with gout have not received this information from their health care providers and view the disease as present only when they are experiencing a flare. 3 The chronic nature of the disease is reflected in the current definition of gout as "current or prior clinically evident disease", as agreed by international gout experts. 4 Gout is a systemic disease and an established independent risk factor for renal and cardiovascular disease.…”

“…Given that for most patients gout manifests as an intermittently flaring disease, with most flares lasting 7–10 days, respondents would likely not report their gout to be “current” or “likely to last 6 months” unless they have a clear understanding that gout is a chronic disease of monosodium urate crystal deposition. Many people with gout have not received this information from their health care providers and view the disease as present only when they are experiencing a flare . The chronic nature of the disease is reflected in the current definition of gout as “current or prior clinically evident disease”, as agreed by international gout experts .…”

The role of diet in serum urate concentration

“…Only a minority of patients taking drugs increase the dose to achieve the target serum urate level required to rid the body of causative crystals, prevent flares, and shrink tophi 11. The reasons for poor management of gout are not fully understood, but patients’ and practitioners’ suboptimal understanding of gout, its causes, and treatment are considered to be important factors 1213…”