Objective We sought to examine patients’ and providers’ views on the treatment of gout to better understand why management is suboptimal. Methods In-depth telephone interviews were conducted with gout patients (n=26) who initiated treatment with a urate-lowering drug (ULD) in the prior 6 months and with providers who care for gout patients (n=15). The interviews were audiotaped and transcribed verbatim. Using qualitative methods, results were analyzed and themes were identified. Interviews focused on the acute management, chronic management, and prevention and improvement strategies. Results Providers viewed the majority of patients as having excellent relief with nonsteroidal anti-inflammatories, colchicine and glucocorticoids while some patients felt these medications were ineffective. Providers felt most patients had a good understanding of the rationale for ULD therapy and that patients responded well. Some patients felt ULDs triggered, worsened or had no impact on their disease. Most providers thought medication adherence was relatively good. Some patients reported discontinuing medications. Discontinuations were largely purposeful and due to clinical or financial concerns. Most providers thought their skills adequate to teach disease self-management behaviors. Patients requested more information and longer visit times. Conclusions Providers view gout as easily managed while patients report challenges and purposeful nonadherence.

Very little rigorous research has been conducted on reducing unnecessary medications in frail older adults or patients approaching end of life.

Older women with osteoporosis need clear information about their condition, including the diagnosis, the implications of the diagnosis, treatment options, medication effectiveness and side effects. Physicians should check with their patients to confirm understanding and address concerns, as older women may not always voice their reservations and concerns.

Perceived medical errors can impact both the patient and the family in many ways. We recommend that providers acknowledge the full impact of a perceived error and tailor their response to meet the specific needs of the patient and family.