This paper examines reasons for lack of urate-lowering therapy (ULT) in many patients with gout, using patient interviews to explore patient experience with, and understanding of, such therapy.
Summary |
- Current literature demonstrates that there is a need for improved quality of care for patients with gout, but the reasons behind the current suboptimal management of such patients remain to be fully elucidated.
- To explore reasons for under prescription of ULT and poor adherence to such therapy, researchers conducted a qualitative study, using face-to-face semi-structured interviews with 43 participants in their homes or workplaces within the UK.
- Three anticipated themes (knowledge and understanding of gout, experience using ULT, information needs) and two emergent themes (resistance to medication and uncertainty about starting ULT) were discussed.
- Knowledge and understanding of gout and its treatment:
- Perceptions and understanding of gout influenced attitude to treatment – failing to see it as serious or long-term reduced likelihood of taking ULT.
- Understanding could change over time, moving patients towards increased likelihood of taking ULT.
- Resistance to medication:
- Reasons for such resistance included the long-term nature of treatment, sense of identity, dislike of multiple medications and desire for self-management.
- Uncertainty about whether and/or when to start ULT:
- Many patients discussed an ‘acceptable’ number of attacks, which may lead to patients continuing to experience regular attacks, following a wait and see approach to medication.
- Patients' experiences of taking ULT:
- A key theme was the patient feeling that the process of achieving the right dosage was one of trial and error, which could be frustrating for patients, particularly when combined with a lack of explanation.
- Desire for information and monitoring:
- Most knew little about gout prior to diagnosis, and the impact of long-term treatment on patients was often underestimated by healthcare practitioners. Patients expressed a desire for ongoing dialogue with their healthcare professional.
- This study suggests that rather than prescription as a GP issue and adherence as a patient issue, patient factors play an important role in the decision to prescribe, and GPs can influence whether patients continue to take prescribed medication.
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Richardson JC, Liddle J, Mallen CD, Roddy E, Hider S, Prinjha S, Ziebland S. BMC Musculoskelet Disord. 2016;17:249. doi: 10.1186/s12891-016-1117-5.