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Coleman W, Spencer D, Wong P, Manolios N. An enquiry into the crippling gout affecting Pacific Islander and Māori men in Western Sydney. Int J Rheum Dis 2021; 24:1394-1401. [PMID: 34611996 DOI: 10.1111/1756-185x.14222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
AIM Despite the effectiveness and availability of urate-lowering therapies (ULT), we continue to see a number of advanced cases of tophaceous gout in the Pacific Islander and Māori population in Western Sydney. Although the high prevalence and increased severity of gout in this cohort has been well documented, there has been little qualitative research undertaken in Australia into the lived experience of this group of people. It is this gap in the research that our study aimed to address. METHODS Participants were recruited from the rheumatology clinics at Westmead and Blacktown Hospitals. Those eligible to participate were Pacific Islander and Māori patients with tophaceous gout currently living in the Western Sydney Local Health District (WSLHD). Data collection took the form of 10 semi-structured interviews, which were subsequently transcribed verbatim. A thematic analysis of the data was then performed. RESULTS Thematic analysis identified 6 key themes: lack of understanding of the disease and its potential effects; missed opportunities for intervention and disjointed care; chronic reliance upon corticosteroids; trivialization of gout as a nuisance illness; the substantial financial impact of chronic illness; and the all-consuming nature of severe gout. CONCLUSION The human cost of severe tophaceous gout in this cohort is immense. All 10 participants exemplified the disease's devastating social effects. We propose 4 key recommendations: improved education regarding diagnosis and management; immediate prescription of ULT at first presentation; a lower threshold for out-of-hospital rheumatologist referral; and improved follow-up through a nurse- and pharmacist-led collaborative gout management program.
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Affiliation(s)
- William Coleman
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - David Spencer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
| | - Peter Wong
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia.,Rural Clinical School Coffs Harbour Campus, The University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Manolios
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
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Robinson PC. Gout models of care: The next step is to facilitate implementation. Int J Rheum Dis 2020; 23:1115-1116. [DOI: 10.1111/1756-185x.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Philip C. Robinson
- University of Queensland Faculty of Medicine Brisbane Qld Australia
- Royal Brisbane & Women’s Hospital Metro North Hospital & Health Service Brisbane Qld Australia
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Phang KF, Santosa A, Low BPL, Tan PSH, Khong ZW, Lim AYN, Teng GG, Tay SH. A nurse-led, rheumatologist-assisted telemedicine intervention for dose escalation of urate-lowering therapy in gout. Int J Rheum Dis 2020; 23:1136-1144. [PMID: 32483906 DOI: 10.1111/1756-185x.13855] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023]
Abstract
AIMS Urate-lowering therapy (ULT) is effective in gout, but suboptimal management with wide variability in dose escalation remains widespread. We protocolized dose escalation of ULT to improve gout management. The aim was to reduce time to achieve target serum urate (SU) <360 µmol/L. METHODS Process improvement tools were used to identify underlying causes of prolonged time to target SU. We designed a nurse-led telemedicine intervention for dose escalation of ULT. Patients with gout with SU ≥360 µmol/L meeting indications for ULT at a single institution were recruited. Exclusion criteria were estimated glomerular filtration rate <30 mL/min, pregnancy, cognitive impairment and poor mobility. A nurse-led telemedicine clinic was set up to perform patient education, monitoring of adverse events and drug escalation. We partnered with primary healthcare centers for routine blood tests. RESULTS From July 2016 to December 2017, 127 patients were recruited. Median time to target SU was 19.0 weeks (interquartile range [IQR] 11.0-31.0). Median dose of allopurinol was 300 mg/d (IQR 200-400) in normal renal function and lower in renal impairment. Median telemedicine calls required to achieve target SU was 2 (IQR 1-3). No patient was hospitalized for gout flares. Two patients had adverse drug reactions, one required cessation of allopurinol for rash with eosinophilia, the other had self-resolving ulcers and allopurinol was continued. Lower baseline SU and number of gout flares were associated with attainment of target SU. CONCLUSION A nurse-led telemedicine for gout care is effective and safe. Our results affirm the utility of telemedicine in increasing access to care and lower healthcare utilization.
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Affiliation(s)
- Kee Fong Phang
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bernadette P L Low
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Pamela S H Tan
- Department of Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Zhi Wei Khong
- Department of Surgery, Singapore General Hospital, Singapore
| | - Anita Y N Lim
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gim Gee Teng
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Robinson PC. Adherence to allopurinol in patients with gout: further insights generate further questions. THE LANCET. RHEUMATOLOGY 2020; 2:e249-e250. [PMID: 38273472 DOI: 10.1016/s2665-9913(20)30060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/27/2024]
Affiliation(s)
- Philip C Robinson
- University of Queensland School of Clinical Medicine, Faculty of Medicine, Brisbane, QLD 4006, Australia.
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