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Gout patients better at sticking to treatment with nurse-led care

Patients with gout prefer nurse care over GP care according to study, which also reported better long-term outcomes associated with a nurse-led programme. 

It follows previous work by the same team which showed the nurse-led approach using ‘treat to target’ and patient education reduced flare-ups and improved quality of life.

The team is now assessing the effectiveness of training practice nurses to carry out the management of patients with gout.

Researchers at Nottingham University found that patients receiving nurse-led care had greater satisfaction with healthcare practitioners, had better knowledge of their condition, were more likely to be taking urate-lowering treatment, and self-reported fewer flares in the previous 12 months than those receiving GP-led care.

The majority of the 358 patients who filled in the questionnaire said they preferred receiving gout treatment from a nurse, the team reported in Rheumatology.

Currently, it is estimated that only 40% of gout patients receive urate-lowering therapy and those that do usually receive a fixed-dose without titration.

The researchers said adherence is also usually poor and patients were not often followed up properly.

Study leader Dr Abhishek Abhishek, clinical associate professor of rheumatology at the University of Nottingham, said: ‘There is a gap in how well we manage people with gout and one of the problems with gout treatment is there had not been a lot of research showing that urate-lowering treatment can reduce flares.'

He added that the study had used research nurses to educate patients and initiate and monitor treatment. The next step is to test the approach in the real world as well as producing more evidence of the treat-to-target approach.

‘There is no reason why nurses who are trained to do other chronic disease management can’t do this as well.’

Dr Louise Warburton, a GP with special interest in MSK in Shropshire and a researcher at Keele University, said it was unsurprising that patients preferred the nurse care option in the study when they would have had more time and input than the GP would have been able to offer.

But she said the idea of practice nurses taking on board gout management as part of their chronic disease remit made sense.

‘GPs don’t do this very well and with the best will in the world, even I don’t have a list of gout patients I need to follow up. It’s partly because it’s not in QOF so there’s no incentive to review these patients and also many GPs will have not had current learning on this.

‘There is really quite good evidence now that you reduce joint damage you reduce long term complications.'

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