Interventions to improve uptake of urate-lowering therapy in patients with gout: a systematic review

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>Gout treatment is suboptimal despite available therapy, with low levels of initiation and persistence of urate-lowering therapy (ULT) in many patients.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To identify all interventions that have attempted to improve the uptake of ULT and analyse the clinical outcomes.</jats:p></jats:sec><jats:sec><jats:title>Design &amp; setting</jats:title><jats:p>A systematic review of international articles published in English.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>A systematic search was conducted through MEDLINE, Embase, CINAHL Plus, and Scopus databases to identify all studies on relevant interventions for gout. Interventions were included if they aimed to address patient adherence with serum urate (SU) level as an outcome. This included patient education, practitioner monitoring, medication titration, SU monitoring, and ongoing patient engagement and follow-up. Follow-up studies to original interventions and those with only an abstract available were included.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Twenty articles met the inclusion criteria, describing outcomes of 18 interventions conducted in primary care settings: six nurse-led, five pharmacist-led, and seven multidisciplinary, multifaceted interventions. Improvement in SU levels was observed in all interventions. Nurse-led interventions were effective at empowering patients as they addressed illness perceptions and provided education, advice, and telephone follow-up. Pharmacist-led interventions primarily aimed to monitor patients, alter medication dosage, and provide automated telephone follow-up. Various multifaceted programmes involving a range of providers resulted in increased sustained use of urate-lowering medication.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>A nurse-led approach focusing on patient understanding about gout is the most effective in achieving improved patient adherence, and lowered SU levels among patients. An intervention should include patient education and follow-up components.</jats:p></jats:sec>

Gout models of care: The next step is to facilitate implementation

“…Pharmacist‐led care can yield success rates of 35%‐82% 7‐9 . Other interventions focusing on education, goal setting and reinforcement in a variety of settings have also shown promising results 1 …”

“…This is slowly changing in small pockets though, for example, with the tsunami of type 2 diabetes mellitus a large team of critical healthcare professionals in the form of diabetes nurse educators, nutritionists, dieticians and nurse practitioners often provide a large proportion of the required care. We now have a growing body of literature from around the world that adapting care from traditional models to meet the needs of patients with gout can dramatically improve outcomes 1 . Gout needs to have its “type 2 diabetes moment” and be recognized as an important problem that requires a disease‐specific solution to address.…”

“…Research has identified patient, provider and health system issues as contributing to these poor outcomes. However, there have been a series of studies demonstrating the value of alternate models of care in gout 1 . Standard models in primary care yield rates of reaching serum urate (SU) targets of between 22%‐30% 2‐4 .…”

“…[7][8][9] Other interventions focusing on education, goal setting and reinforcement in a variety of settings have also shown promising results. 1 Kee Fong Phang and colleagues report on a model of gout care that is nurse-led, rheumatologist-assisted telemedicine partnered with regional primary healthcare centers in Singapore. 10 Included patients had rheumatologist-diagnosed gout who required urate-lowering therapy (ULT).…”

“…We now have a growing body of literature from around the world that adapting care from traditional models to meet the needs of patients with gout can dramatically improve outcomes. 1…”