Medscape: What did you find?
Dr Fields: We found that at 12 months, 85% of the patients rated the program highly for usefulness in understanding how to manage their gout, results that were published last year in Seminars in Arthritis and Rheumatism. At 12 months, 81% highly rated the nursing portion of the program, and 50% of them highly rated the pharmacist program, so there was a difference between the interventions. That's something we found helpful.
Among the most frequently missed questions on the gout self-efficacy exam related to the long-term possibility of being gout-free. Patients didn't really understand that an appropriate goal was to have no gout attacks at all. Some of them still thought that having some attacks was okay. Some of them also missed the question about the important genetic component of gout. A large percentage of the patients seemed to think of gout as primarily a dietary disease.
Secondary outcomes showed that there was an improvement from a median of two gout attacks at baseline to one attack per 6 months, at 6 and 12 months. So, there was improvement. Severely painful attacks were down to 13% at 6 months and 8% at 12 months, from 60% at baseline. So, significant improvement also occurred here.
The overall takeaway from our study is that a multidisciplinary approach is a reasonable option for further study, and that other groups could benefit from some of the things that we found. Our findings could also be a guide for clinicians and researchers who are trying to develop new studies on the optimal gout management team.
Medscape: How common are multidisciplinary approaches to gout management?
Dr Fields: People have looked at similar, yet not as multidisciplinary, approaches in the past. There was research on a nurse gout management done at the University of Nottingham in the United Kingdom, and a pharmacist-led program at Kaiser Permanente in California. But no one else to our knowledge has done it with multidisciplinary groups—which we think can be effective, because the time commitment from each individual group can be lessened, and each discipline can use its special skill sets to the patient's advantage.
Medscape: Has this approach been broadly adopted yet by your institutions, HSS and Cornell?
Dr Fields: We have a large rheumatology division with about 40 rheumatologists, and the nurses for our program have all been trained to be able to give our gout questionnaire and also to be able to teach the gout curriculum to any patient who comes in. Our rheumatologists have the option of having the nurse meet with their new patients with gout, and the social workers are integral parts of the team to address psychosocial concerns. So it is in effect right now.
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Cite this: A Simple Intervention to Improve Patient Education and Adherence in Gout - Medscape - Apr 06, 2017.