Patient awareness, knowledge and use of colchicine: an exploratory qualitative study in the Counties Manukau region, Auckland, New Zealand

Abstract

IntroductIon: Treatment of gout, specifically with colchicine, varies globally. Colchicine can be fatal due to its narrow therapeutic index and potential for interactions. In New Zealand, cases of intentional and unintentional colchicine overdose have been documented. AIms:To explore patients' knowledge on the use of gout medicines, and in particular their awareness of the maximum dose of colchicine, the dangers of colchicine overdose, and their opinions on restricting colchicine dispensing. The study also investigates where patients receive gout information.methods: Thirty people with gout presenting to their regular gout clinic in Auckland currently or previously taking colchicine were invited to participate in a 30-min semi-structured interview. Data were analysed using a general inductive thematic approach.FIndIngs: Overall, participants had a lack of knowledge regarding colchicine and used variable doses during an acute gout attack. Participants were unsure of the maximum dose of colchicine and several took more than prescribed. The prophylactic use of colchicine and allopurinol varied from 3 weeks to 15 years. Mixed views were reported on restricting colchicine supply. Most participants received gout information from their general practitioner (GP).conclusIon: Poor understanding of colchicine contributed to inappropriate use and highlights the need for targeted patient education. Considerable inter-patient variability exists in the use of colchicine for acute gout, suggesting the efficacy of low dose regimens be explored. The length of adjunctive colchicine use, as part of a prophylaxis regimen, needs to be regularly reviewed and tailored to each patient. Further research is required on limiting the amount of colchicine dispensed.

Colchicine: the good, the bad, the ugly and how to minimize the risks

“…In addition to unauthorized access, inappropriate colchicine dosing for gout flares is the other situation that should be avoidable with education about the risks and benefits and the correct dosing of colchicine. People with gout report increasing the dose of colchicine in an attempt to control gout flares [ 86 ]. This has risks and it is important that people with gout know to seek medical attention if a gout flare fails to settle as expected with colchicine rather than simply taking more.…”

From the Editor: He aha te mea nui o te ao?

“…Rebello et al 5 found that patients poorly understand their gout medications and Humphrey et al 6 found that their GPs and nurses know this but do not really know what to do about it. Both studies develop suggestions to improve care for patients with gout.…”