1
|
Emad Y, Derksen C, Petrie KJ, Dalbeth N. A content analysis of medication adherence material in patient educational resources about gout. Rheumatol Adv Pract 2024; 8:rkae042. [PMID: 38629107 PMCID: PMC11018534 DOI: 10.1093/rap/rkae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/09/2024] [Indexed: 04/19/2024] Open
Abstract
Objective This study aimed to investigate how medication adherence is addressed in online gout resources in six countries. We investigated how often adherence was referred to, the strategies suggested to improve patient adherence, and the types of nonadherence that were targeted. We also examined the readability of the adherence material. Methods A content analysis was conducted on 151 online gout resources from medical and health organisations in six predominantly English-speaking countries. Two reviewers coded the content of the websites into categories (kappa 0.80). The analysis involved coding the resources for reasons for nonadherence, and adherence-promoting strategies. Flesch-Kincaid Reading Ease scores and word count were also computed. Results Out of 151 websites examined, 77 websites discussed medication adherence (51%), with intentional nonadherence being more prevalent than unintentional nonadherence. 67 websites targeted different types of nonadherence, including drug-specific concerns (50%), misconceptions of gout curability and the necessity of medication (16%), forgetfulness (16%), and other practical challenges (5%). Strategies to promote adherence were found in one-third of the websites, with medication education being the most prevalent strategy (17%), followed by healthcare provider engagement (13%) and memory aid strategies (6%). On average, about 11% of the words (89.27, SD = 76.35) in the entire document were focused on adherence. Difficult reading comprehension was found in one-fifth of adherence-related websites. Conclusion Findings reveal limited medication adherence coverage and narrow strategies in online gout resources. Improved adherence portrayal is needed for effective gout management through comprehensive strategies and clear, understandable information.
Collapse
Affiliation(s)
- Yasaman Emad
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Christina Derksen
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Lamb KL, Barker ME, Lynn A. A content analysis of online videos containing dietary recommendations for gout and their alignment with evidence-based dietary guidelines. Public Health Nutr 2023; 26:2014-2025. [PMID: 37577941 PMCID: PMC10564598 DOI: 10.1017/s136898002300160x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To assess the alignment of YouTube® videos providing dietary recommendations for gout with evidence-based guidelines targeted at the United Kingdom (UK) population and to establish their quality. DESIGN A content analysis of YouTube® videos providing dietary recommendations for gout was undertaken. Videos were categorised by video source. Each video's dietary recommendations for gout were compared with three evidence-based guidelines for gout, producing a compliance score. Presence of non-guideline advice was assessed. Understandability and actionability were evaluated using the Patient Education Material Assessment Tool for Audio-Visual Materials. Reliability was assessed using an adapted-DISCERN tool and educational quality using the Global Quality Score Five-Point Scale. Differences between video source and continuous variables were assessed using one-way Kruskal-Wallis H tests. For categorical variables, associations were investigated using Fisher-Freeman-Halton tests. SETTING Online, May-June 2020. PARTICIPANTS One-hundred thirty-one videos. RESULTS Alignment of videos with evidence-based guidelines was poor (median compliance score 27 % (interquartile range 17-37 %)). Additionally, 57 % of videos contained non-guideline advice. The health professional source group had the fewest videos containing non-guideline advice, but this was only significantly lower than the naturopath group (31 % v. 81 %, P = 0·009). Almost 70 % of videos were considered poorly actionable and 50 % poorly understandable. Most videos were rated poor for reliability (79 %) and poor to generally poor for educational quality (49 %). CONCLUSIONS YouTube® videos providing dietary recommendations for gout frequently fail to conform to evidence-based guidelines, and their educational quality, reliability, understandability and actionability are often poor. More high-quality, comprehensive, evidence-based YouTube® videos are required for UK gout patients.
Collapse
Affiliation(s)
- Kirstie Louise Lamb
- Food and Nutrition Group, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | - Margo E Barker
- Food and Nutrition Group, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | - Anthony Lynn
- Food and Nutrition Group, Sheffield Hallam University, Sheffield, S1 1WB, UK
| |
Collapse
|
3
|
Conley B, Bunzli S, Bullen J, O’Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PF, Nikpour M, Grainger R, Lin I. What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines. BMC Rheumatol 2023; 7:15. [PMID: 37316871 PMCID: PMC10268528 DOI: 10.1186/s41927-023-00335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Gout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs. METHODS Gout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched. RESULTS Six CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan. CONCLUSION Management of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care. TRIAL REGISTRATION The protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7 ).
Collapse
Affiliation(s)
- Brooke Conley
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
| | - Samantha Bunzli
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
| | | | - Penny O’Brien
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Jennifer Persaud
- Arthritis and Osteoporosis Western Australia, Perth, WA Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA Australia
| | - Tilini Gunatillake
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Peter F Choong
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Level 2, Clinical Sciences Building, 29 Regent St, Fitzroy, VIC 3065 Australia
| | - Mandana Nikpour
- Departments of Medicine and Rheumatology, The University of Melbourne at St. Vincent’s Hospital, Melbourne, VIC Australia
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Te Whatu Ora Health New Zealand – Capital Coast and Hutt Valley, Wellington, New Zealand
| | - Ivan Lin
- The University of Western Australia, Western Australian Centre for Rural Health, Geraldton, WA Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, WA Australia
| |
Collapse
|
4
|
Ahmadzadeh K, Bahrami M, Zare-Farashbandi F, Adibi P, Boroumand MA, Rahimi A. Patient education information material assessment criteria: A scoping review. Health Info Libr J 2023; 40:3-28. [PMID: 36637218 DOI: 10.1111/hir.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources. OBJECTIVE This paper aims to identify these criteria and recognize the tools or methods used to evaluate them. METHODS National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included. RESULTS Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability. CONCLUSION This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria.
Collapse
Affiliation(s)
- Khadijeh Ahmadzadeh
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Student Research Commitee, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Masoud Bahrami
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Zare-Farashbandi
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Payman Adibi
- Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Boroumand
- Department of Medical Library and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rahimi
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
5
|
Russell MJ, Kim S, Lenert A. A patient-centered gout information value chain: a scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:30-43. [PMID: 34120817 PMCID: PMC8651807 DOI: 10.1016/j.pec.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine and identify the scope of research addressing health information requirements for gout patients using value chain analysis. METHODS Five electronic databases (PubMed, CINAHL, ERIC, PsycINFO, Embase, and Scopus) and grey literature (WorldCat) were searched in accordance with a published protocol. Only English language articles were included, with no limitations for date of publication. The findings of the 33 studies included for final analysis were subsequently divided into 6 groups according to the stages of the care delivery value chain their research most closely pertained to: screening/preventing (n = 2), diagnosing (n = 1), preparing (n = 7), intervening (n = 11), recovering/rehabilitating (n = 5), and monitoring/managing (n = 13). RESULTS The 33 studies focused on one or more of the following information phenotypes: 1) pathophysiology; 2) medical treatment; and 3) nonpharmaceutical interventions. Long term treatment adherence was a popular topic amongst studies that focused on gout patient education. CONCLUSION Based on the identified studies, gout patients are being told what to do, but are not being adequately educated regarding why recommended interventions are important or how to accomplish them. PRACTICE IMPLICATIONS This review provides a foundation to develop and evaluate personalized education materials using value chain analysis.
Collapse
Affiliation(s)
- Maranda J Russell
- Department of Communication, College of Communication and Information & Division of Biomedical Informatics, College of Medicine, University of Kentucky, USA
| | - Sujin Kim
- Division of Biomedical Informatics, College of Medicine & School of Information Science, College of Communication and Information, University of Kentucky, USA.
| | - Aleksander Lenert
- Division of Immunology, Carver College of Medicine, University of Iowa, USA
| |
Collapse
|
6
|
Krasnoryadtseva A, Derksen C, Dalbeth N, Petrie KJ. Not Every Picture Tells a Story: A Content Analysis of Visual Images in Patient Educational Resources About Gout. J Rheumatol 2020; 47:1815-1821. [DOI: 10.3899/jrheum.191245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 01/23/2023]
Abstract
Objective.The aim of this study was to evaluate which concepts about gout and its treatment are reflected in images in online educational resources about gout.Methods.A Google search was performed to identify English-language patient resources from medical and health organizations and health education websites in 7 countries: Australia, Canada, Ireland, New Zealand, South Africa, UK, and USA. Two raters independently coded the images in the resources into 5 main categories: clinical presentations of gout, urate/monosodium urate (MSU) crystals, medicines, food/healthy lifestyle, and other advice for people with gout.Results.In total, 103 resources were identified; 28 resources without images were excluded. Seventy-one educational resources with a total of 310 images were included in the study sample. Of the 310 images, clinical presentations of gout were depicted in 92 images (30%), food/healthy lifestyle in 73 images (24%), urate/MSU crystals in 50 (16%), medicines in 14 (5%). Urate-lowering medication was shown only in 1 image (0.3%) and just 6 images (2%) depicted a serum urate target. Ninety-one images (29%) did not convey specific information about gout.Conclusion.Key concepts about gout and treatment are underrepresented in the images used in educational resources for patients. A large proportion of the images do not convey useful information about gout or its management.
Collapse
|
7
|
Krasnoryadtseva A, Dalbeth N, Petrie KJ. The effect of different styles of medical illustration on information comprehension, the perception of educational material and illness beliefs. PATIENT EDUCATION AND COUNSELING 2020; 103:556-562. [PMID: 31601448 DOI: 10.1016/j.pec.2019.09.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore how the addition of a medical illustration and its style affected information comprehension, perception of educational material and illness beliefs. METHODS 204 people recruited in a supermarket were randomised to read one of the four leaflets about gout and fill out a questionnaire. Three leaflets had a picture showing gout in the form of a cartoon, an anatomical drawing or a computed tomography scan (CT). The control leaflet did not contain images. RESULTS Seeing an illustrated leaflet helped correctly identify treatment for gout X2(1, N = 204) = 5.51, p=0.019. Out of the three images, only the cartoon was better than text in conveying information about treatment X2(1, n = 102) = 8.84, p=0.018. Participants perceived illustrated leaflets as more visually appealing t(70) = 3.09, p = 0.003, and the anatomical image was seen as more helpful for understanding of the illness than the cartoon. Pictures did not significantly influence lay illness perceptions about gout. CONCLUSION Pictures aid the understanding of health information and increase the visual appeal of materials. While simpler illustrations convey information more effectively, people prefer more detailed anatomical images; CT scans offer no benefits over simpler images. PRACTICE IMPLICATIONS The results can help guide the use of images in gout education material.
Collapse
Affiliation(s)
- Alina Krasnoryadtseva
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
8
|
Ramsubeik K, Ramrattan LA, Kaeley GS, Singh JA. Effectiveness of healthcare educational and behavioral interventions to improve gout outcomes: a systematic review and meta-analysis. Ther Adv Musculoskelet Dis 2018; 10:235-252. [PMID: 30515250 PMCID: PMC6262501 DOI: 10.1177/1759720x18807117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We aimed to systematically review the effectiveness of healthcare behavioral and education interventions for gout patients on clinical outcomes. METHODS We searched multiple databases to identify trials or observational studies of educational or behavioral interventions in gout. Risk of bias was assessed with the Cochrane tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale for observational studies. We estimated odds ratios (ORs) for categorical and standardized mean difference (SMD) for continuous measures using a random-effects model. RESULTS Overall, eight (five RCTs and three observational) studies met the inclusion criteria and examined pharmacist-led interventions (n = 3), nurse-led interventions (n = 3) and primary care provider interventions (n = 2). Compared with the control intervention (usual care in most cases), a higher proportion of those in the educational/behavioral intervention arm achieved serum urate (SU) levels <6 mg/dl, 47.2% versus 23.8%, the OR was 4.86 [95% confidence interval (CI), 1.48, 15.97; 4 RCTs] with moderate quality evidence. Compared with the control intervention, a higher proportion of those in the educational/behavioral intervention arm were adherent to allopurinol, achieved at least a 2 mg/dl decrease in SU, achieved an SU < 5 mg/dl, had a reduction in the presence of tophi at 2 years, had improved quality of life as assessed with SF-36 physical component scores, had a higher knowledge about gout and higher patient satisfaction (moderate-low quality evidence). CONCLUSION Educational and behavioral interventions can improve gout outcomes in the short-intermediate term. Randomized trials are needed to assess its impact on long-term gout outcomes.
Collapse
Affiliation(s)
- Karishma Ramsubeik
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Laurie Ann Ramrattan
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Gurjit S. Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Jasvinder A. Singh
- Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham VA Medical Center, Faculty Office Tower 805B, 510 20th Street South, Birmingham, AL, 35294, USA
| |
Collapse
|
9
|
Robinson PC. Gout - An update of aetiology, genetics, co-morbidities and management. Maturitas 2018; 118:67-73. [PMID: 30415758 DOI: 10.1016/j.maturitas.2018.10.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023]
Abstract
Gout is an increasingly common chronic disorder of urate crystal deposition that manifests as flares of acute inflammatory arthritis. Hyperuricaemia is a prerequisite and a fifth of both men and woman are hyperuricaemic. The prevalence of gout is much lower than the prevalence of hyperuricaemia for reasons that are not currently clear. Gout is more common in men than women prior to menopause due to the uricosuric effects of oestrogen, but after menopause the incidence of gout rises substantially in women. Co-morbidities are an important issue in gout, with cardiovascular disease, diabetes mellitus, obesity and chronic kidney disease all common in patients with gout. Environmental factors like diet affect the incidence of gout but there is little evidence to support an emphasis on diet in treating established gout. The diagnosis of gout is often made without the use of joint aspiration and validated diagnostic rules are available for both primary and secondary care as well as classification criteria for research use. The overarching principle of the management of gout with pharmacotherapy is the need to reduce serum urate levels to below a target of 0.30 mmol/L or 0.36 mmol/L depending on whether it is tophaceous or non-tophaceous respectively. The use of allopurinol has been researched extensively and newer strategies for safer effective dosing are now recommended. Newer agents have been introduced for the treatment of gout, including febuxostat and lesinurad. A number of important questions in the field are under current investigation.
Collapse
Affiliation(s)
- Philip C Robinson
- University of Queensland School of Clinical Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, Queensland, 4006, Australia.
| |
Collapse
|
10
|
Nguyen AD, Frensham LJ, Wong MX, Meslin SM, Martin P, Lau AY, Baysari MT, Day RO. mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies. JMIR Mhealth Uhealth 2018; 6:e182. [PMID: 30322835 PMCID: PMC6305897 DOI: 10.2196/mhealth.9811] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/25/2018] [Accepted: 06/29/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. OBJECTIVE The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. METHODS Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. RESULTS Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. CONCLUSIONS These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app's presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients.
Collapse
Affiliation(s)
- Amy D Nguyen
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Lauren J Frensham
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Michael Xc Wong
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Sylvain Mm Meslin
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Paige Martin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Annie Ys Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Melissa T Baysari
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Richard O Day
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Darlinghurst, Australia.,School of Medical Sciences, University of New South Wales Sydney, Sydney, Australia
| |
Collapse
|
11
|
Goals of gout treatment: a patient perspective. Clin Rheumatol 2018; 37:2557-2566. [PMID: 30078087 DOI: 10.1007/s10067-018-4243-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/14/2018] [Accepted: 07/25/2018] [Indexed: 01/13/2023]
Abstract
To assess the goals of gout treatment from a patient perspective, a convenience sample of consecutive patients with doctor-diagnosed gout seen at a community-based outpatient clinic were invited. Sex-stratified nominal groups were conducted until saturation was achieved. Responses were collected verbatim, discussed, and rank-ordered by each participant. Thirty-six patients with doctor-diagnosed gout participated in 12 nominal groups: 6 male only, 5 female only, and 1 group with both. Mean age was 61.9 years (SD, 12.3); mean gout duration was 13.3 years (SD, 12.5); 53% were men, 64% African-American, 42% retired, 47% currently married, 87% were using either allopurinol and/or febuxostat, and 40% had had no gout flares in the last 6 months. The top 5 treatment goals accounted for 91% of all votes and included the following: (1) prevent and better manage flare-ups and improve function (25%), (2) eliminate flare-ups/disease remission (30%), (3) diet and activity modification/lifestyle change (13%), (4) patient education and public awareness (12%), and (5) medication management and minimization of side effects (11%). When examining the top-rated concern for each nominal group, the first two goals were nominated by four groups each, diet/activity modification and medication management by 1 group each, and patient education by 3 groups. There were no differences evident by sex in top-ranked treatment goal. People with gout identified and rank-ordered treatment goals relevant to them. Providers of gout care need to be cognizant of these goals. Disease management concordant with these treatment goals might lead to a more satisfied, informed patient.
Collapse
|
12
|
Abhishek A, Doherty M. Education and non-pharmacological approaches for gout. Rheumatology (Oxford) 2018; 57:i51-i58. [PMID: 29272507 DOI: 10.1093/rheumatology/kex421] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 12/17/2022] Open
Abstract
The objectives of this review are as follows: to highlight the gaps in patient and physician knowledge of gout and how this might impede optimal disease management; to provide recommended core knowledge points that should be conveyed to people with gout; and to review non-pharmacological interventions that can be used in gout management. MeSH terms were used to identify eligible studies examining patients' and health-care professionals' knowledge about gout and its management. A narrative review of non-pharmacological management of gout is provided. Many health-care professionals have significant gaps in their knowledge about gout that have the potential to impede optimal management. Likewise, people with gout and the general population lack knowledge about causes, consequences and treatment of this condition. Full explanation about gout, including the potential benefits of urate-lowering treatment (ULT), motivates people with gout to want to start such treatment, and there is evidence, albeit limited, that educational interventions can improve uptake and adherence to ULT. Additionally, several non-pharmacological approaches, such as rest and topical ice application for acute attacks, avoidance of risk factors that can trigger acute attacks, and dietary interventions that may reduce gout attack frequency (e.g. cherry or cherry juice extract, skimmed milk powder or omega-3 fatty acid intake) or lower serum uric acid (e.g. vitamin C), can be used as adjuncts to ULT. There is a pressing need to educate health-care professionals, people with gout and society at large to remove the negative stereotypes associated with gout, which serve as barriers to optimal gout management, and to perceive gout as a significant medical condition. Moreover, there is a paucity of high-quality trial evidence on whether certain simple individual dietary and lifestyle factors can reduce the risk of recurrent gout attacks, and further studies are required in this field.
Collapse
Affiliation(s)
- Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| |
Collapse
|
13
|
Retreatment with Pegloticase after a Gap in Therapy in Patients with Gout: A Report of Four Cases. Rheumatol Ther 2018; 5:583-594. [PMID: 29725991 PMCID: PMC6251856 DOI: 10.1007/s40744-018-0111-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Pegloticase, a potent uricolytic biologic enzyme, has been shown to be an effective therapeutic option in patients with uncontrolled gout. However, there are limited data on clinical response after a gap in therapy and retreatment with pegloticase. Case Series This report describes four patients with chronic gout who were successfully managed with pegloticase and were retreated following a gap in therapy. Patient charts from a practice-based rheumatology clinic were retrospectively analyzed; four male patients, aged 70–75 years, with chronic gout and a more than 4-week gap in pegloticase therapy were reviewed. Before pegloticase treatment, patients had received allopurinol or febuxostat, but they continued exhibiting symptoms, including visible tophi and serum uric acid (SUA) levels of 5.2–10.2 mg/dL (309–607 μmol/L), despite oral urate-lowering therapy. The first pegloticase treatment (8-mg infusion every 2 weeks) lasted 22–124 weeks. Pegloticase resolved tophi and improved SUA to below 1.5 mg/dL (less than 89 μmol/L); however, patients discontinued pegloticase because of symptom resolution, poor adherence, or personal reasons. Following treatment gaps (12–156 weeks), symptoms and SUA levels increased and patients were retreated with pegloticase (4–147 weeks). In three of four patients, reinitiating pegloticase lowered SUA levels to below 1.0 mg/dL (less than 59 μmol/L) and resolved symptoms. One patient experienced an infusion reaction and discontinued; no infusion reactions, gout flares, or adverse events occurred among the other three patients. Conclusion Retreatment with pegloticase after a gap in therapy appears to be an effective and tolerated option in prior responders. Funding Horizon Pharma.
Collapse
|
14
|
Abstract
Gout is the most common form of inflammatory arthritis and is a considerable burden to patients and health care systems worldwide. Despite its clinical, economic, and social impact, patient persistence and adherence to prescribed urate-lowering therapies (ULT), ranging from 20% to 70%, is considered to be among the poorest of all chronic conditions. The majority of gout patients consequently receive suboptimal benefits of their prescribed pharmacotherapies. As gout is associated with several comorbidities along with an increased risk of premature mortality, achieving improved outcomes through adherence to ULT is crucial. Adherence to medication is complex and multidimensional and includes a combination of treatment-, patient-, and physician-related factors. This review explores the factors related to ULT adherence with the overall aim of helping health care providers better understand the barriers to adherence. Several interventions targeting pharmacists, nurses, and patients are being investigated to improve adherence. Furthermore, enhanced awareness and understanding of the need to treat-to-target in order to improve patient outcomes is needed among health care professionals. Greater understanding of the multidimensional nature of non-adherence can help physicians to treat gout more effectively and empower patients to improve self-management of this long-term disease.
Collapse
Affiliation(s)
| | - Giovambattista Desideri
- Geriatric Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Gout management is currently suboptimal despite excellent available therapy. Gout patient education has been shown to enhance medication adherence and self-management, but needs improvement. We explored the literature on gout patient education including gaps in gout patient knowledge; use of written materials; in-person individual and group sessions; education via nurses, pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile health app, and text messaging educational efforts. RECENT FINDINGS Nurse-led interventions have shown significant improvement in reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a lesser degree. A multi-disciplinary approach has shown feasibility. Needs-assessments, patient questionnaires, and psychosocial evaluations can enhance targeted education. An interactive and patient-centered approach can enhance gout educational interventions. Optimal programs will assess for and address educational needs related to knowledge gaps, health literacy, race, gender, socio-economic status, and level of social support.
Collapse
Affiliation(s)
- Theodore R Fields
- Division of Rheumatology, Hospital for Special Surgery, 535 East 70th St., Suite 848-West, New York, NY, 10021, USA.
- Weill Cornell College of Medicine, New York, NY, USA.
| | - Adena Batterman
- Department of Social Work Programs, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
16
|
Rolston CJ, Conner TS, Stamp LK, Neha T, Pitama S, Fanning N, Janes R, Judd A, Hudson B, Hegarty RM, Treharne GJ. Improving gout education from patients’ perspectives: a focus group study of Māori and Pākehā people with gout. J Prim Health Care 2018; 10:194-200. [DOI: 10.1071/hc18010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT INTRODUCTION Gout is a common form of arthritis that is typically managed in primary care. Gout management guidelines emphasise patient education for successful treatment outcomes, but there is limited literature about the educational experiences of people living with gout in New Zealand, particularly for Māori, who have higher gout prevalence and worse gout outcomes than Pākehā. AIM To explore gout patient education in primary care from the perspectives of Māori and Pākehā people with gout. METHODS In total, 69 people with gout were recruited through primary care providers in three locations across New Zealand. Nine semi-structured focus groups were run with Māori and Pākehā participants in separate groups. RESULTS Thematic analysis yielded two themes in relation to gout education: (i) ‘Multiple sources of gout education’; and (ii) ‘Gaps in gout knowledge’. Participants received education from general practitioners, educational resources, family and friends, and their own experiences. Māori participants preferred information to be kanohi-ki-te-kanohi (face-to-face) and with significant others present where necessary. Participants disclosed gaps in gout’s epidemiology and management. Pākehā and Māori participants reported limited understanding of the genetic basis of gout or the biological underpinnings of the condition and its treatments, but learned treatment adherence through experience. DISCUSSION Despite improved gout patient education, knowledge gaps remain and may contribute to poor medication adherence. Gout patient education interventions need to be tailored to culture and incorporate suitable methods of disseminating information about gout management.
Collapse
|
17
|
Tran BNN, Ruan QZ, Epstein S, Ricci JA, Rudd RE, Lee BT. Literacy analysis of National Comprehensive Cancer Network patient guidelines for the most common malignancies in the United States. Cancer 2017; 124:769-774. [DOI: 10.1002/cncr.31113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/01/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Bao Ngoc N. Tran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Qing Z. Ruan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Sherise Epstein
- Department of Social and Behavioral Sciences; Harvard T. H. Chan School of Public Health; Boston Massachusetts
| | - Joseph A. Ricci
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Rima E. Rudd
- Department of Social and Behavioral Sciences; Harvard T. H. Chan School of Public Health; Boston Massachusetts
| | - Bernard T. Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| |
Collapse
|
18
|
Derksen C, Serlachius A, Petrie KJ, Dalbeth N. "What say ye gout experts?" a content analysis of questions about gout posted on the social news website Reddit. BMC Musculoskelet Disord 2017; 18:488. [PMID: 29169350 PMCID: PMC5701290 DOI: 10.1186/s12891-017-1856-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/17/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Social media is increasingly used by patients to source information for managing chronic disease. The aim of this study was to understand patient information needs about gout by a content analysis of questions posted on the social news website Reddit. METHODS We analysed questions posted onto the 'Gout sufferers unite' subreddit site. Two reviewers coded questions into categories (inter-reviewer kappa 0.70), with discordant coding resolved by a third reviewer. Data were analysed by calculating the frequency of questions within the categories. Where relevant, categories were further separated into sub-categories to allow organisation and interpretation of the data. RESULTS We analysed 359 questions in 287 posts by 213 individuals. A wide range of questions arose. The single most common category related to uncertainty of diagnosis (22.3% questions), with questions about disease management common. Information-seeking about medications was generally cautious, with questions about side-effects, risk of flares after starting urate-lowering therapy, and decision to start urate-lowering therapy. Community users experiencing flares posted questions about flare management, including medications, sometimes in real-time. Dietary management questions included the effectiveness of dietary changes as a management strategy, choice of alcoholic beverage, and weight loss strategies. Questions about serum urate levels were rare (2.8% questions). CONCLUSIONS Questions about gout posted on the subreddit site most often related to uncertainty about symptoms and disease management strategies, with infrequent questions about serum urate testing, results or targets. These findings may inform development of strategies to address the information needs of people with gout.
Collapse
Affiliation(s)
- Christina Derksen
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand.
| |
Collapse
|
19
|
Jimenez-Liñan LM, Edwards L, Abhishek A, Doherty M. Adequacy of Online Patient Information Resources on Gout and Potentially Curative Urate-Lowering Treatment. Arthritis Care Res (Hoboken) 2017; 69:748-752. [PMID: 27390083 DOI: 10.1002/acr.22981] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/03/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the content and readability of online patient information resources against the current understanding of gout. METHODS An online survey was undertaken using Google UK, USA, Australia, and Canada. Information was assessed for content and accuracy on 19 key points regarding core content for gout patient information resources. Readability was assessed using the Flesch-Kincaid Reading Ease score. Fifteen randomly selected websites were reviewed by a blinded second observer. RESULTS A total of 85 websites were selected. More than 50% of the websites provided no information or had inaccuracies regarding the pathogenesis of gout. Most websites contained information on dietary and lifestyle modifications for treating gout and did not emphasize urate-lowering therapy (ULT) and its potential for cure. Over 75% of the websites had no/inaccurate information on the role of ULT or prophylaxis for preventing gout attacks on starting ULT. The majority of websites were difficult to read, with information in 68% of the websites rated at least fairly difficult. CONCLUSION Only a few web-based patient information resources provide accurate and easy-to-read information on gout. This study will help physicians direct patients to currently reliable resources, but there is a need to improve many web-based patient information resources, which at present act as barriers to care.
Collapse
Affiliation(s)
- L M Jimenez-Liñan
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
| | - L Edwards
- University of Nottingham and Nottingham City Hospital, Nottingham, and Royal Derby Hospital, Derby, UK
| | - A Abhishek
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
| | - Michael Doherty
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
| |
Collapse
|
20
|
The rate of adherence to urate-lowering therapy and associated factors in Chinese gout patients: a cross-sectional study. Rheumatol Int 2017; 37:1187-1194. [DOI: 10.1007/s00296-017-3746-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/17/2017] [Indexed: 12/27/2022]
|
21
|
Readability, complexity, and suitability of online resources for mastectomy and lumpectomy. J Surg Res 2017; 212:214-221. [DOI: 10.1016/j.jss.2017.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/29/2016] [Accepted: 01/18/2017] [Indexed: 11/21/2022]
|
22
|
Tran BNN, Singh M, Lee BT, Rudd R, Singhal D. Readability, complexity, and suitability analysis of online lymphedema resources. J Surg Res 2017; 213:251-260. [PMID: 28601323 DOI: 10.1016/j.jss.2017.02.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/14/2017] [Accepted: 02/24/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over 72% of Americans use online health information to assist in health care decision-making. Previous studies of lymphedema literature have focused only on reading level of patient-oriented materials online. Findings indicate they are too advanced for most patients to comprehend. This, more comprehensive study, expands the previous analysis to include critical elements of health materials beyond readability using assessment tools to report on the complexity and density of data as well as text design, vocabulary, and organization. METHODS The top 10 highest ranked websites on lymphedema were identified using the most popular search engine (Google). Website content was analyzed for readability, complexity, and suitability using Simple Measure of Gobbledygook, PMOSE/iKIRSCH, and Suitability Assessment of Materials (SAM), respectively. PMOSE/iKIRSCH and SAM were performed by two independent raters. Fleiss' kappa score was calculated to ensure inter-rater reliability. RESULTS Online lymphedema literature had a reading grade level of 14.0 (SMOG). Overall complexity score was 6.7 (PMOSE/iKIRSCH) corresponding to "low" complexity and requiring a 8th-12th grade education. Fleiss' kappa score was 80% (P = 0.04, "substantial" agreement). Overall suitability score was 45% (SAM) correlating to the lowest level of "adequate" suitability. Fleiss' kappa score was 76% (P = 0.06, "substantial" agreement). CONCLUSIONS Online resources for lymphedema are above the recommended levels for readability and complexity. The suitability level is barely adequate for the intended audience. Overall, these materials are too sophisticated for the average American adult, whose literacy skills are well documented. Further efforts to revise these materials are needed to improve patient comprehension and understanding.
Collapse
Affiliation(s)
- Bao Ngoc N Tran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mansher Singh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Rima Rudd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dhruv Singhal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
23
|
Robinson PC, Kempe S, Tebbutt I, Roberts L. Epidemiology of inpatient gout in Australia and New Zealand: temporal trends, comorbidities and gout flare site. Int J Rheum Dis 2016; 20:779-784. [PMID: 27455925 DOI: 10.1111/1756-185x.12941] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM To assess the epidemiology of inpatient gout in Australia and New Zealand during the years 2009-2014. METHODS Using the Health Roundtable Limited (HRT) dataset, all patients with a coded ICD10 primary or secondary discharge diagnosis of gout from a HRT participating Australian or New Zealand hospital between the years 2009 and 2014 were identified. The number of inpatient gout admissions, length of stay, body site of gout flare, temporal trends and comorbidities were assessed. RESULTS During 2009-2014, the number of gout admissions increased significantly in Australia and New Zealand. The rate of inpatient gout admissions relative to the population and total HRT admissions rose in Australia and stayed static in New Zealand. Lower limb presentations were the commonest anatomical site of gout in admitted patients. Length of stay over the course of the study decreased both in patients admitted for gout and in those in the entire HRT dataset. Patients admitted for gout have longer length of stay compared to patients admitted for other reasons. Cardiovascular disease, infection and stroke were the commonest conditions that were complicated by an episode of inpatient gout. There was no influence of month or season on the pattern of gout admissions. CONCLUSION The number of gout admissions rose in Australia numerically and as a proportion of the total population and total admissions. Gout is an increasing problem affecting individuals and the community as a whole in Australia.
Collapse
Affiliation(s)
- Philip C Robinson
- School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia.,Department of Rheumatology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sarina Kempe
- Department of Rheumatology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Ian Tebbutt
- Health Roundtable Limited, Sydney, New South Wales, Australia
| | - Lynden Roberts
- Department of Rheumatology, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Richardson JC, Liddle J, Mallen CD, Roddy E, Hider S, Prinjha S, Ziebland S. 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. [PMID: 27267878 PMCID: PMC4895958 DOI: 10.1186/s12891-016-1117-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 06/02/2016] [Indexed: 12/31/2022] Open
Abstract
Background Although international guidelines encourage urate lowering therapy (ULT) for people who have more than two attacks of gout, only 30 % of patients are prescribed it and only 40 % of those adhere to the treatment. The aim was to explore reasons for this through an exploration of patient experience and understanding of ULT treatment for gout. Methods A qualitative study was conducted throughout the United Kingdom. Narrative and semi-structured video-recorded interviews and thematic analysis were used. Results Participants talked about their views and experiences of treatment, and the factors that affected their use of ULT. The analysis revealed five main themes: 1) knowledge and understanding of gout and its treatment; 2) resistance to taking medication; 3) uncertainty about when to start ULT; 4) experiences of using ULT; and 5) desire for information and monitoring. Conclusion Patients’ understanding and experiences of gout and ULT are complex and it is important for clinicians to be aware of these when working with patients. It is also important for clinicians to know that patients’ perceptions and behaviour are not fixed, but can change over time, with changes to their condition, with dialogue and increased understanding. Patients want this interaction with their clinicians, through “a joint effort over a period of time”.
Collapse
Affiliation(s)
- Jane C Richardson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK.
| | - Jennifer Liddle
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK
| | - Samantha Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| |
Collapse
|
25
|
Richardson JC, Liddle J, Mallen CD, Roddy E, Prinjha S, Ziebland S, Hider S. "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. [PMID: 26710971 PMCID: PMC4693432 DOI: 10.1186/s12905-015-0277-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/11/2015] [Indexed: 01/21/2023]
Abstract
Background Gout is more common in men, and is often perceived by both patients and health practitioners to be a disorder of men, but its prevalence in women is increasing. Little is known about women’s experience of gout and the impact it has on their lives. It is important for practitioners to be aware of these areas, given the increasing numbers of women with gout they are likely to see in the future. This study aimed to explore women’s experiences of gout. Methods A qualitative research design was used. Semi-structured interviews were conducted with 43 people, of whom 14 were women. Interviews were video and/or tape recorded and transcribed verbatim. Data from the interviews was first grouped into broad categories, followed by a more detailed thematic analysis and interpretation. Results Participants’ ages ranged from 32 to 82. Nine participants were retired and five were in fulltime work. Four themes emerged: (1) experience of onset, help seeking and diagnosis (2) understanding and finding information about gout, (3) impact on identity, and (4) impact on roles and relationships. Conclusions The diagnostic process for women with gout can be uncertain due to lack of awareness of gout in women (by health care professionals and women themselves). Women do not have a good understanding of the condition and find it difficult to find information that feels relevant to them. Gout has a major impact on women’s identity and on their roles and relationships. These findings are of importance to health care professionals dealing with women with potential gout and those with an existing diagnosis.
Collapse
Affiliation(s)
- Jane C Richardson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Jennifer Liddle
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Samantha Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| |
Collapse
|
26
|
Vargas CR, Kantak NA, Chuang DJ, Koolen PG, Lee BT. Assessment of online patient materials for breast reconstruction. J Surg Res 2015; 199:280-6. [PMID: 26088084 DOI: 10.1016/j.jss.2015.04.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/10/2015] [Accepted: 04/21/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited health literacy affects nearly half of American adults and adversely affects patient participation, satisfaction, health care costs, and overall outcomes. As patients increasingly search the Internet for health information, accessibility of online material is critical. Previous studies examining this topic have focused on the readability of these materials. This study evaluates online breast reconstruction resources with regard to reading level, however, adds new metrics to assess degree of complexity, and suitability for the intended audience. METHODS The 10 most popular patient Web sites for "breast reconstruction" were identified using the largest Internet search engine. The content of each site was assessed for readability using the simple measure of gobbledygook analysis, complexity using the PMOSE/iKIRSCH formula, and suitability using the suitability assessment of materials instrument. Resulting scores were analyzed overall and by Web site. RESULTS Readability analysis revealed an overall average grade level of 13.4 (range 10.7-15.8). All sites exceeded the recommended sixth grade level. Complexity evaluation revealed a mean PMOSE/iKIRSCH score of 6.3, consistent with "low" complexity and requiring an 8th-12th grade education; individual sites ranged from "very low" to "high" complexity. Suitability assessment overall produced a mean 41.2% score, interpreted as "adequate" for the intended patient audience. Five of the 10 sites were found to be "not suitable" when examined individually; the remaining five were "adequate." CONCLUSIONS Available online patient material for breast reconstruction is often too difficult for many patients to understand based on readability, complexity, and suitability metrics. Comprehensive assessment is needed to design appropriate patient material and minimize disparities related to limited health literacy.
Collapse
Affiliation(s)
- Christina R Vargas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Neelesh A Kantak
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Danielle J Chuang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Pieter G Koolen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
27
|
Johnston ME, Treharne GJ, Chapman PT, Stamp LK. Patient Information about Gout: An International Review of Existing Educational Resources. J Rheumatol 2015; 42:975-8. [DOI: 10.3899/jrheum.141442] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 11/22/2022]
Abstract
Objective.Inadequate patient information about gout may contribute to poor disease outcomes. We reviewed existing educational resources for gout to identify strengths and weaknesses and compare resources cross-nationally.Methods.Content, readability, and dietary recommendations were reviewed using a sample of 30 resources (print and Web-based) from 6 countries.Results.More than half of the resources were written at a highly complex level. Some content areas were lacking coverage, including comorbidity risks, uric acid target levels, and continuing allopurinol during acute attacks.Conclusion.Our findings suggest significant room for improvement in gout patient educational resources, particularly regarding self-management.
Collapse
|
28
|
Gout: joints and beyond, epidemiology, clinical features, treatment and co-morbidities. Maturitas 2014; 78:245-51. [PMID: 24880206 DOI: 10.1016/j.maturitas.2014.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 02/07/2023]
Abstract
Gout is a common inflammatory arthritis precipitated by an inflammatory reaction to urate crystals in the joint. Gout is increasingly being recognised as a disease primarily of urate overload with arthritis being a consequence of this pathological accumulation. It is associated with a number of important co-morbidities including chronic kidney disease, obesity, diabetes and cardiovascular disease. The prevalence of gout is increasing around the world. Significant progress has been made in determining the genetic basis for both gout and hyperuricaemia. Environmental risk factors for gout have been identified as certain foods, alcohol and several medications. There is, however, little evidence that changing these environmental risks improves gout on an individual level. Treatment of gout encompasses two strategies: firstly treatment of inflammatory arthritis with non-steroidal anti-inflammatories, corticosteroids, colchicine or interleukin-1 inhibitors. The second and most important strategy is urate lowering, to a target of 0.36 mmol/L (6 mg/dL) or potentially lower in those with tophi (collections of crystalline urate subcutaneously). Along with urate lowering, adequate and prolonged gout flare prophylaxis is required to prevent the precipitation of acute attacks. Newer urate lowering agents are in development and have the potential to significantly expand the potential treatment options. Education of patients regarding the importance of life long urate lowering therapy and prophylaxis of acute attacks is critical to treatment success as adherence with medication is low in chronic diseases in general but especially in gout.
Collapse
|