A Simple Intervention to Improve Patient Education and Adherence in Gout

Where Patient Education Is Lacking

Medscape: Tell us a bit about the needs assessment that was part of this project.

Ms Batterman: I'll start by saying that all of our work is very much in alignment with the European League Against Rheumatism (EULAR) recommendations on optimal patient education for patients with inflammatory arthritis. As part of their eight recommendations, EULAR really underscores the need for patient education as an integral part of standard of care to increase patient involvement. They also recommend that content and delivery of patient education needs to be individually tailored to meet patients' needs. So, I think that that's really what our approach was here in developing the pilot study, and also in developing our needs assessment.

The needs assessment that we developed was an offshoot of the gout pilot study. We were looking to identify what patient education needs and preferences, and psychosocial needs, are for patients. We did this in advance of a gout symposium we were hosting, at which Dr Fields was the featured speaker. Before we developed the curriculum for the symposium, we really wanted to hear from patients with gout as to what those knowledge gaps were, and what information and support, from the patients' perspective, would help most with disease self-management.

We developed a gout needs assessment using a 26-item Likert scale survey, and included some open-ended questions to get at the issues I just mentioned. We had 100 people complete the survey, with a mean time of diagnosis of 10.8 years. Most of them were male, of course. Mean age was 64 years, and we saw some major patient knowledge gaps and essential gaps in self-management skills.

Our core findings were related to, as Dr Fields mentioned, outcomes expectations. For example, of patients who had had more than three flares in the preceding 6 months, 33% of them felt that their gout was under control. This clearly indicates that there needs to be more education about what appropriate goals are, meaning no flares. A surprising 51% felt that they did not know enough about how to manage side effects, which of course can affect treatment adherence, so we addressed these issues in the symposium.

When asked what they most wanted to hear about, a good portion of the respondents discussed the need for more nutritional guidance, specifically from a nutritionist. So, to follow up on that, we included a nutritionist in the symposium. It seemed that it was important for the patients whom we studied that they hear specifically from that discipline. And, with reference to Dr Fields' earlier point about the role of diet, both Dr Fields and the nutritionist worked together on this. We saw this as an opportunity to present a consistent message about the role of diet in a comprehensive gout management plan.

We're going to be following up the needs assessment with further outreach and looking at some additional findings. We presented our preliminary findings at American College of Rheumatology annual meeting.^[2]

Medscape: Do either of you have any final comments about how your findings could affect practice for clinicians who manage gout?

Dr Fields: Many studies have shown how poorly patients with gout are managed. There's also an interesting study comparing adherence to medication in gout vs in six other diseases: hypertension, hypothyroidism, diabetes, seizure disorders, high cholesterol, and osteoporosis.^[3] It turns out that adherence in gout was the worst of all of them. I think that really supports the fact that we need a comprehensive approach to help these patients stay on their medications. We think that the multidisciplinary approach that we used may be very useful in settings that have all of these different types of professionals under one roof.

That said, I think we've also learned some things about patients' responses to each part of the team, which may help groups that don't have all these types of professionals available. We think that using either the whole team, or just parts of the team, may help develop a more effective approach to patients with gout. This is clearly needed, because many patients with gout are not doing nearly as well as they could be.

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