“I can’t bend it and it hurts like mad”: direct observation of gout consultations in routine primary health care

Abstract

BackgroundGout is the most common form of inflammatory arthritis and is associated with considerable co-morbidity. It is usually managed in the primary care setting with a combination of lifestyle modification and pharmacological therapy. This study describes patterns of communication about gout observed in interactions between patients and primary care practitioners during routine consultations.MethodsSecondary analysis of video-recordings of individual healthcare consultations between patients and a range of primary care practitioners (including general practitioners, practice nurses, podiatrists and dietitians) from an archived database. Consultations that included any discussion about gout were eligible for inclusion (n = 31) and were not restricted to those where gout was the main presenting complaint. The consultation transcripts were analysed using a qualitative inductive approach from clinical and linguistic perspectives and supplemented with visual observation of the interactions.ResultsTwo main themes emerged from the data; the importance of gout and ‘telling’ versus ‘listening’ in consultations. The first theme had two distinct strands; gout as an incidental part of the consultation and the impact of gout on patients. A trend towards more didactic practitioner communication encompassed by the second theme occurred at many different consultation points including diagnosis, in more general post-diagnosis discussion, and when discussing biochemical test results and lifestyle advice. In contrast, when discussion about treatment with medicines occurred a tendency towards a greater degree of listening to patients was observed.ConclusionOur observation of the communication patterns in these consultations illustrates an inherent complexity of gout consultations in primary care. Gout may be more important to patients than is often apparent to practitioners in routine consultations. Consultation management needs to take into account the impact of the condition and the balance of information provided around lifestyle advice versus long-term management with medicines.

The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial

“…Previous studies have confirmed that improving disease-related knowledge level and compliance with ULT positively influences patients with gout to reach the SUA goal [ 9 10 ]. Unfortunately, in patients with gout, disease-related knowledge is not adequate, especially for the duration of ULT [ 11 ], target SUA level [ 11 ], and drug-related knowledge [ 12 ]. Some studies also showed that the compliance with ULT in China was only 9.6% [ 13 ].…”