A qualitative study to explore health professionals’ experience of treating gout: understanding perceived barriers to effective gout management
Chloe Humphrey 1 , Richard Hulme 2 , Nicola Dalbeth 3 4 , Peter Gow 5 , Bruce Arroll 6 , Karen Lindsay 4 7 81 Medical student, University of Auckland
2 East Tamaki Healthcare
3 Department of Medicine, University of Auckland
4 Department of Rheumatology, Auckland District Health Board
5 Department of Rheumatology, Counties Manukau District Health Board
6 Department of General Practice and Primary Health Care, University of Auckland
7 Department of Immunology, Auckland District Health Board, NZ
8 Correspondence to: Karen Lindsay, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand. Email: klindsay@adhb.govt.nz
Journal of Primary Health Care 8(2) 149-156 https://doi.org/10.1071/HC15017
Published: 30 June 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: The management of gout is challenging and mainly occurs in primary care. This study aims to explore the experience of treating gout among primary care clinicians and understand the perceived barriers to effective therapy.
METHODS: Fourteen health professionals from primary care practices in South Auckland were recruited. Each participated in a semi-structured interview exploring their experience of treating and managing gout patients were analysed thematically.
FINDINGS: Participants described the large burden of gout in their communities and the importance of the clinician–patient relationship in gout management. Four themes summarise the perceived barriers to effective urate lowering therapy (ULT); unique gout factors, eg its intermittent nature and potential for stigmatisation; systemic barriers to optimal treatment, or barriers that emerge from working within a certain organisation; uncertainty about ownership, or who should carry responsibility for overcoming barriers to optimal treatment; and cultural barriers to optimal treatment.
CONCLUSION: Clinicians in primary practice perceive gout management to be mainly acute rather than preventive care. Patients may be stigmatised and management difficult particularly when diet is emphasised over ULT. Practice nurses are a group potentially available and willing to assist in educating patients. These findings may be helpful in planning for and improving healthcare in gout.
KEYWORDS: Gout; general practice; uric acid; primary health care; allopurinol; primary prevention
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