Background African-Americans share a disproportionate burden of gout compared to Caucasians, with a higher prevalence, lower likelihood of treatment with ULT including allopurinol, higher rates of non-adherence with ULT and higher baseline serum urate and lower odds of achieving target serum urate <6 mg/dl. To our knowledge, there are no studies investigating the reasons for poor medication adherence in African-Americans with gout.
Objectives To examine the facilitators and barriers to adherence to urate-lowering therapy (ULT) in African-Americans with gout.
Methods Nine nominal groups lasting 1-1.5 hour each were conducted in African-Americans with gout, six with low ULT and three with high ULT adherence (medication possession ratios of <0.80 or ≥0.80, respectively). Patients presented, discussed, combined and rank ordered their concerns. A qualitative analysis was performed.
Results 43 patients with mean age 63.9 years (standard deviation, 9.9), 67% men, participated in nine nominal groups (seven in men, two in women): African-American men (n=30); African-American women (n=13). The main facilitators to ULT adherence (three groups) were the recognition of the need to take ULT regularly to prevent gout flares, prevent pain from becoming chronic/severe and to have less dietary restriction; the lack of side effects from ULT; trust in physicians; and avoiding the need to seek emergent/urgent care for flares. Patients achieved high ULT adherence by organizing their pills using the pillbox and the incorporation of ULT intake into their routine to prevent forgetting. The main barriers to optimal ULT adherence were (six groups): doubts about effectiveness of ULT, concerns about cost and side effects, concomitant medications, forgetfulness, refilling the prescriptions on time, pill size and difficulty in swallowing, competing priorities, patient preference for alternative medicines (i.e. cherry juice) and frequent travel.
Conclusions Identification of facilitators and barriers to high ULT adherence in African-Americans with gout in this study lays the foundation for designing interventions to improve ULT adherence in racial minorities.
Acknowledgements This material is the result of work supported by a grant from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center, Alabama, USA. J.A.S. is also supported by grants from the Agency for Health Quality and Research Center for Education and Research on Therapeutics (CERTs), National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS), National Institute of Aging (NIA) and National Cancer Institute (NCI).
Disclosure of Interest J. Singh Grant/research support: Takeda, savient, Consultant for: Takeda, savient, regeneron, allergan