Nurse-led gout care that in part involves patient education and engagement can significantly increase adherence to urate-lowering treatment and the likelihood of achieving target serum urate levels, according to a new study.
British investigators randomly assigned 517 patients who had experienced a gout flare within the previous 12 months to receive either nurse-led care (255 patients) or usual care provided by a physician (262 patients). The primary outcome was the proportion of patients who achieved a target serum urate levels below 6 mg/dL at 2 years. Nurses involved in the study received training about gout and its management. Nurses provided patients with holistic assessment, discussion of illness perceptions, and full information on gout, and encouraged patients to share in decision making.
Results showed that 94.9% of patients in the nurse-led care group achieved the target serum urate level at 2 years compared with 29.7% in the usual-care group, Michael Doherty, MD, of the University of Nottingham in Nottingham, UK, and colleagues reported in The Lancet. Nurse-led care was associated with a significant 3-fold greater likelihood of achieving the target serum urate level than usual care.
At baseline, the nurse-led care group and usual-care group had similar proportions of patients taking urate-lowering therapy (39.6% vs 38.9%). At 2 years, however, the nurse-led care group, compared with the usual-care group, had a significantly higher proportion of patients taking urate-lowering therapy (96.1% vs 56.1%).
At baseline, approximately 80% of both groups experienced 2 or more gout flares in the previous 12 months. The nurse-led care group, compared with the usual-care group, had a significantly lower proportion of patients experiencing 2 or more flares during year 2 (8.0% vs 24.2%).
“Our results highlight the importance and success of individualised education and care of patients, a principle that should be considered by any health-care professional who manages people with gout,” the authors concluded.
With regard to study limitations, Dr Doherty’s team noted that recruitment may have been subject to selection bias if participating practices were interested in gout. Similarly, if patients concerned about gout were more likely to participate, the study population could have been subject to response bias.
In an accompanying editorial, Tuhina Neogi, MD, PhD, of Boston University School of Medicine, and Nicola Dalbeth, MBChB, MD, of the University of Auckland in New Zealand, commented that the Dr Doherty and his colleagues “show a path forward for improved gout outcomes, demonstrating a package of care that leads to sustained adherence and clinical benefits through individualised education focusing on the central concept of gout as a chronic disease of urate crystal deposition and through using a well tolerated proactive treat-to-target approach.”
Doherty M, Jenkins W, Richardson H, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet. 2018;392:1403-1412.
Neogi T, Dalbeth N. Patient education and engagement in treat-to-target gout care. Lancet. 2018;392:1379-1380.