What factors contribute to uncontrolled gout and hospital admission? A qualitative study of inpatients and their primary care practitioners

Abstract

ObjectiveTo provide deeper insight into why patients are admitted to hospital with gout and discover potential targets for better disease control.DesignData from semi-structured interviews were analysed using a thematic analysis approach.Participants and settingEleven inpatients from a tertiary institution in the Australian Capital Territory of Australia and their respective general practitioners (GPs) were invited to participate in the semi-structured interviews.ResultsDespite significant pain and disability that accompanied acute flares, patients continue to experience shame in seeking treatment and regarded gout as being not particularly important. Other barriers included patients’ poor continuity of care with and lack of confidence in GPs, suboptimal management in outpatient and inpatient settings, poor understanding of disease and treatment, and misconceptions held by both patients and physicians leading to uncontrolled disease activity.ConclusionsBarriers to optimal gout management including patient and health practitioner factors have produced a complex effect which has led to a cycle of treatment avoidance behaviours and recurrent hospitalisations for severe acute gout flares. These barriers could be addressed using a multipronged approach guided by the chronic care model which has been applied in a variety of other chronic diseases with improved patient and professional-level outcomes. Managing gout according to best practice for chronic disease is more likely to prevent recurrent hospitalisations and improve health outcomes in patients with gout.

An enquiry into the crippling gout affecting Pacific Islander and Māori men in Western Sydney

“…Similar themes were also noted in a recent ACT study. 8 A major barrier to effective management appears to be a lack of knowledge and understanding of gout, its treatment, and, when poorly controlled, its potentially severe long-term outcomes. This lack of knowledge was a key barrier emerging from qualitative studies in the UK 22 and New Zealand.…”

“…A literature search revealed that although the high prevalence and increased severity of gout in this population had been welldocumented, [4][5][6][7] little research had looked into their lived experience. A recent Australian Capital Territory (ACT) 8 study had looked at factors contributing to acute flare-ups requiring admission, but did not address long-standing tophaceous disease. A number of studies in New Zealand (NZ) 7,[9][10][11] and the United Kingdom (UK) 12,13 had highlighted gout's impact on such individuals and communities; however, no study had explored this in the Australian healthcare setting.…”

Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout

“…People with gout experience shame in seeking treatment for gout, 96 feel stigmatised that their gout diagnosis is associated with perceptions of dietary and alcohol excess and identify they do not have enough information about gout. 97 …”

“…94 Serum urate monitoring allows the dose of medication to be titrated to a target serum urate of below 6 mg/dL (360 μmol/L) in those with symptomatic gout and often below 5 mg/dL (300 μmol/L) in those with features of severe gout such as tophi. 94 Healthcare and workforce considerations People with gout experience shame in seeking treatment for gout, 96 feel stigmatised that their gout diagnosis is associated with perceptions of dietary and alcohol excess and identify they do not have enough information about gout. 97 Approaches that support patient understanding of gout, strengthen primary care and focus on strong Crystal arthropathies Crystal arthropathies Crystal arthropathies relationships between clinician and patient are important in management to enable patients to manage gout and continue urate-lowering therapy.…”

Associations Between the NLRP3 and IL-1β Gene Polymorphisms and Gout Susceptibility

“…Gout is a kind of in ammatory arthritis caused by the monosodium urate(MSU) crystals deposited in joints and the surrounding soft tissues,which derives from long-standing hyperuricemia [1] .The course of gout include four stages:asymptomatic hyperuricemia,acute gouty arthritis,intercritical gout and chronic gouty arthritis [2] .Patients can suffer signi cantly attack mainly about the joint pain with sudden onset,fever,redness and swelling when acute gout episodes [3] .This process can affect the patient's quality of life seriously,even functional disability,therefore,gout aroused people's attention increasingly.Nevertheless,with the continuous improvement of people's dietary patterns and lifestyle,the prevalence of gout are on the increase remarkable [4] .A large number of epidemiological data showed that the prevalence of gout in the world is about 0.1-10% on average [5][6] .In western developed countries,there are 3-6% of men and 1-2% of women have gout [7] .There is evidenced that [8] the prevalence of gout is more than 1% in Japanese men who older than 30 years,and in China,there might be 2 per 100 inhabitants suffer from gout [9] . At present,the pathogenesis of gout is still in exploration.Previous studies have con rmed that environmental,diet and genetic factors play roles in the development and incidence of gout.For example,vegetarian diet can reduce the risk of gout in Taiwan by Chiu THT et al [10] .And from a genetic standpoint,substantial genome-wide association studies(GWAS), meta-analyses and case-control studies have found that ABCG2,PKD2,SLC2A9,KCNQ1,SLC22A12,SLC17A1,NLRP3 and so on gene polymorphism are in uence the susceptibility of gout [11][12] .Researchers also agreed that genetic factors are the main factors affecting the onset of gout.…”