Skip to main content
Home
Latest news
Browse topics
Lupus Rheumatoid arthritis Spondyloarthropathies COVID-19 Browse all topics
In focus
Bimekizumab: Dual IL-17A/IL-17F inhibition in SpA Anifrolumab for the treatment of SLE JAK inhibitor safety: Weighing up the data and understanding the risks Rituximab and rheumatology practice in the COVID-19 era Safety snapshot: Upadacitinib in patients with PsA Repurposing rheumatology drugs for COVID-19 Telemedicine in rheumatology: COVID-19 and beyond Managing PsA in resource-limited settings
Conferences
ACR Convergence 2022 EULAR 2022 Congress
About us
Medicine Matters Rheumatology
EXTENDED SEARCH
Top

01-06-2018 | Gout | Article

How patients with gout become engaged in disease management: a constructivist grounded theory study

Journal: Arthritis Research & Therapy

Authors: Alyssa Howren, Susan M. Cox, Kam Shojania, Sharan K. Rai, Hyon K. Choi, Mary A. De Vera

Publisher: BioMed Central

Login to get access

Abstract

Background

Prior qualitative research on gout has focused primarily on barriers to disease management. Our objective was to use patients’ perspectives to construct an explanatory framework to understand how patients become engaged in the management of their gout.

Methods

We recruited a sample of individuals with gout who were participating in a proof-of-concept study of an eHealth-supported collaborative care model for gout involving rheumatology, pharmacy, and dietetics. Semistructured interviews were used. We analyzed transcripts using principles of constructivist grounded theory involving initial coding, focused coding and categorizing, and theoretical coding.

Results

Twelve participants with gout (ten males, two females; mean age, 66.5 ± 13.3 years) were interviewed. The analysis resulted in the construction of three themes as well as a framework describing the dynamically linked themes on (1) processing the diagnosis and management of gout, (2) supporting management of gout, and (3) interfering with management of gout. In this framework, patients with gout transition between each theme in the process of becoming engaged in the management of their gout and may represent potential opportunities for healthcare intervention.

Conclusions

Findings derived from this study show that becoming engaged in gout management is a dynamic process whereby patients with gout experience factors that interfere with gout management, process their disease and its management, and develop the practical and perceptual skills necessary to manage their gout. By understanding this process, healthcare providers can identify points to adapt care delivery and thereby improve health outcomes.
Literature
1.
Neogi T, Hunter DJ, Chaisson CE, Allensworth-Davies D, Zhang Y. Frequency and predictors of inappropriate management of recurrent gout attacks in a longitudinal study. J Rheumatol. 2006;33:104–9.PubMed
2.
Lottmann K, Chen X, Schadlich PK. Association between gout and all-cause as well as cardiovascular mortality: a systematic review. Curr Rheumatol Rep. 2012;14:195–203.CrossRefPubMedPubMedCentral
3.
Fisher MC, Rai SK, Lu N, Zhang Y, Choi HK. The unclosing premature mortality gap in gout: a general population-based study. Ann Rheum Dis. 2017;76:1289–94.CrossRefPubMed
4.
Rai SK, Avina-Zubieta JA, McCormick N, De Vera MA, Shojania K, Sayre EC, et al. The rising prevalence and incidence of gout in British Columbia, Canada: population-based trends from 2000 to 2012. Semin Arthritis Rheum. 2017;46:451–6.CrossRefPubMed
5.
De Vera MA, Marcotte G, Rai S, Galo JS, Bhole V. Medication adherence in gout: a systematic review. Arthritis Care Res. 2014;66:1551–9.CrossRef
6.
Cottrell E, Crabtree V, Edwards JJ, Roddy E. Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice. BMC Fam Pract. 2013;14:170.CrossRefPubMedPubMedCentral
7.
Singh JA, Hodges JS, Toscano JP, Asch SM. Quality of care for gout in the US needs improvement. Arthritis Rheum. 2007;57:822–9.CrossRefPubMedPubMedCentral
8.
Roddy E, Zhang W, Doherty M. Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations. Ann Rheum Dis. 2007;66:1311–5.CrossRefPubMedPubMedCentral
9.
Doherty M, Jansen TL, Nuki G, Pascual E, Perez-Ruiz F, Punzi L, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71:1765–70.CrossRefPubMed
10.
Wise E, Khanna PP. The impact of gout guidelines. Curr Opin Rheumatol. 2015;27:225–30.CrossRefPubMed
11.
Rees F, Jenkins W, Doherty M. Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis. 2012;72:826–30.CrossRefPubMed
12.
Goldfien R, Pressman A, Jacobson A, Ng M, Avins A. A pharmacist-staffed, virtual gout management clinic for achieving target serum uric acid levels: a randomized clinical trial. Perm J. 2016;20:18–23.PubMedPubMedCentral
13.
Goldfien RD, Ng MS, Yip G, Hwe A, Jacobson A, Pressman A, et al. Effectiveness of a pharmacist-based gout care management programme in a large integrated health plan: results from a pilot study. BMJ Open. 2014;4:e003627.CrossRefPubMedPubMedCentral
14.
Green J, Britten N. Qualitative research and evidence based medicine. BMJ. 1998;316:1230–2.CrossRefPubMedPubMedCentral
15.
Rai SK, Choi H, Choi SHJ, Townsend A, Shojania K, De Vera M. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies. Rheumatology (Oxford). 2018; https://​doi.​org/​10.​1093/​rheumatology/​kex530.
16.
Singh JA. Facilitators and barriers to adherence to urate-lowering therapy in African-Americans with gout: a qualitative study. Arthritis Res Ther. 2014;16:R82.CrossRefPubMedPubMedCentral
17.
Singh JA, Herbey I, Bharat A, Dinnella JE, Pullman-Mooar S, Eisen S, et al. Gout self-management in African-American veterans: a qualitative exploration of challenges and solutions from patients’ perspectives. Arthritis Care Res. 2017;69:1724–32.CrossRef
18.
De Vera MA, Howren A, Tsao N, Choi H, Kydd A, Friesen K, et al. THU0442 eHealth supported collaborative care model for gout involving rheumatology, pharmacy, and dietetics: proof of concept observational study [abstract]. Ann Rheum Dis. 2017;76(Suppl 2):374–375.
19.
Charmaz K. Constructing grounded theory. 2nd ed. London: Sage; 2014.
20.
Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23:334–40.CrossRefPubMed
21.
de Klerk E, van der Heijde D, Landewe R, van der Tempel H, van der Linden S. The compliance-questionnaire-rheumatology compared with electronic medication event monitoring: a validation study. J Rheumatol. 2003;30:2469–75.PubMed
22.
de Klerk E, van der Heijde D, van der Tempel H, van der Linden S. Development of a questionnaire to investigate patient compliance with antirheumatic drug therapy. J Rheumatol. 1999;26:2635–41.PubMed
23.
Hughes LD, Done J, Young A. A 5 item version of the Compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDs. BMC Musculoskelet Disord. 2013;14:286.CrossRefPubMedPubMedCentral
24.
Hughes LD, Young A, Done D, Treharne G. A five item Compliance Questionnaire for Rheumatology (CQR5) can effectively predict low adherence to DMARDs in rheumatology clinics [abstract 184]. Rheumatology (Oxford). 2010;49(Suppl 1):i103.
25.
Kvale S. InterViews: an introduction to qualitative research interviewing. Thousand Oaks, CA: Sage; 1996.
26.
Leech BL. Asking questions: techniques for semistructured interviews. PS Polit Sci Polit. 2002;35:665–8.CrossRef
27.
Van Camp YPM, Bastiaens H, Van Royen P, Vermeire E. Qualitative evidence in treatment adherence. In: Olson K, Young RA, Schultz IZ, editors. Handbook of qualitative research for evidence-based practice. New York: Springer; 2016. p. 373–90.CrossRef
28.
Glaser B, Strauss A. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine; 1967.
29.
Bowen GA. Naturalistic inquiry and the saturation concept: a research note. Qual Res. 2008;8:137–52.CrossRef
30.
Chandratre P, Mallen CD, Roddy E, Liddle J, Richardson J. “You want to get on with the rest of your life”: a qualitative study of health-related quality of life in gout. Clin Rheumatol. 2015;35:1197–205.CrossRefPubMedPubMedCentral
31.
Harrold LR, Mazor KM, Velten S, Ockene IS, Yood RA. Patients and providers view gout differently: a qualitative study. Chronic Illn. 2010;6:263–71.CrossRefPubMedPubMedCentral
32.
Liddle J, Roddy E, Mallen CD, Hider SL, Prinjha S, Ziebland S, et al. Mapping patients’ experiences from initial symptoms to gout diagnosis: a qualitative exploration. BMJ Open. 2015;5:e008323.CrossRefPubMedPubMedCentral
33.
Lindsay K, Gow P, Vanderpyl J, Logo P, Dalbeth N. The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. J Clin Rheumatol. 2011;17:1–6.CrossRefPubMed
34.
Martini N, Bryant L, Te Karu L, Aho L, Chan R, Miao J, et al. Living with gout in New Zealand: an exploratory study into people's knowledge about the disease and its treatment. J Clin Rheumatol. 2012;18:125–9.CrossRefPubMed
35.
Richardson JC, Liddle J, Mallen CD, Roddy E, Hider S, Prinjha S, et al. A joint effort over a period of time: factors affecting use of urate-lowering therapy for long-term treatment of gout. BMC Musculoskelet Disord. 2016;17:249.CrossRefPubMedPubMedCentral
36.
Richardson JC, Liddle J, Mallen CD, Roddy E, Prinjha S, Ziebland S, et al. “Why me? I don’t fit the mould ... I am a freak of nature”: a qualitative study of women’s experience of gout. BMC Womens Health. 2015;15:122.CrossRefPubMedPubMedCentral
37.
Singh JA. The impact of gout on patient's lives: a study of African-American and Caucasian men and women with gout. Arthritis Res Ther. 2014;16:R132.CrossRefPubMedPubMedCentral
38.
Singh JA. Challenges faced by patients in gout treatment: a qualitative study. J Clin Rheumatol. 2014;20:172–4.CrossRefPubMedPubMedCentral
39.
Spencer K, Carr A, Doherty M. Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis. 2012;71:1490–5.CrossRefPubMed
40.
Te Karu L, Bryant L, Elley CR. Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study. J Prim Health Care. 2013;5:214–22.PubMed
41.
Vaccher S, Kannangara DR, Baysari MT, Reath J, Zwar N, Williams KM, et al. Barriers to care in gout: from prescriber to patient. J Rheumatol. 2016;43:144–9.CrossRefPubMed
42.
van Onna M, Hinsenveld E, de Vries H, Boonen A. Health literacy in patients dealing with gout: a qualitative study. Clin Rheumatol. 2015;34:1599–603.CrossRefPubMed
43.
Horne R, Weinman J, Barber N, Elliott R, Morgan M. Concordance, adherence and compliance in medicine taking: report for the National Coordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO). London: NCCDSO; 2005.
44.
Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47:555–67.CrossRefPubMed
45.
Morse JM. What use is it anyway? Considering modes of application and contributions of qualitative inquiry. In: Olson K, Young RA, Schultz IZ, editors. Handbook of qualitative health research for evidence-based practice. New York: Springer; 2016. p. 429–40.CrossRef
Image Credits