Background Despite gout's well-known pathogenesis and the availability of effective urate-lowering therapy (ULT), management remains poor. However, limited research has sought to improve care among this patient population. An in-depth understanding of provider and patient perspectives on barriers to the delivery of optimal gout care is critical to informing the development of evidence-based interventions to effectively improve disease management and patient outcomes.
Objectives To systematically review and thematically synthesize qualitative studies to date reporting provider and patient barriers to gout management.
Methods We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies reporting provider and patient perspectives on gout management. Thematic synthesis was used to combine the source studies and identify key themes across studies. Two authors independently read and annotated the data and after discussion agreed on an initial coding framework. Concepts were organized into descriptive themes, and the relationships between these descriptive themes were further explored to develop higher-order analytical themes.
Results Our search strategy retrieved 2,750 articles after the removal of duplicates. After full-text review, 20 studies spanning several geographic settings worldwide (i.e., the US, the UK, New Zealand, Australia, and the Netherlands) met all inclusion criteria and were included in our systematic review. Of these, 16 studies reported gout patient perspectives (n=480 patients), while only 7 studies reported provider perspectives (n=120 providers, including general practitioners, rheumatologists and other specialists, and allied health professionals). Thematic synthesis identified three predominant interlocking analytical themes among providers: (a) knowledge gaps and management approaches, (b) perceptions and beliefs about gout patients, and (c) system barriers to optimal gout care (Table 1). We further identified four predominant themes among gout patients: (a) limited gout knowledge (e.g., the “curable” nature of gout), (b) attitudes toward taking medication, (c) interactions with healthcare providers, and (d) practical barriers to chronic medication use (Table 1).
Conclusions Our thematic synthesis identified several barriers to gout care, particularly knowledge gaps among both providers and patients as well as implementation barriers to the provision of optimal care. Knowledge translation initiatives emphasizing the “curable” nature of gout targeting both providers and patients as well as strategies to reduce system barriers and support regular medication use are urgently needed to improve gout care.
Acknowledgements This study was supported in part by a grant from the Canadian Institutes of Health Research (PCS 146388). We wish to thank the Arthritis Patient Advisory Board of Arthritis Research Canada for providing their consumer input into this project.
Disclosure of Interest None declared