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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.'

Readers' comments (13)

  • How much time did the nurses spend in total with the patients?

    Even in 10 mins, I will diagnose, treat, explain pathophysiology, need for urate monitoring and give a patient information leaflet. I do not, however, keep recalling patients more than annually.

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  • GP monkey @5.14pm.

    "Even in 10 mins..." says a lot. I know you have 10 minutes but really, hand on heart, are you saying that you have considered the secondary causes carefully before concluding its a primary case (ie cut booze, eat better blah blah).

    There can be more to "gout" that meets the eye.Heres a snippet for you- patient with gout getting more episodes despite taking the pills and cleaning up his life.Urate checked and up after being normal. Have more pills was the treatment. Lymphoproliferative disorder diagnosis delayed because "its gout" and patient was not examined or a rpt FBC taken.

    Ten minutes is inadequate time to do a proper job, and even simple stuff can be indicative of more serious issues.

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  • Vinci Ho

    Time is a resource , as I always said ( alongside with expertise, manpower and money at the same time).
    More resources, better outcomes. Common sense . This applies in all other areas .
    On the matter of secondary causes : more commonly ,drug related e.g. thiazides and renal impairment from all causes (and of course urate stones can further impair the kidneys ) may be overlooked .
    And for our own dermatological interest, high cell turnover in psoriasis also increases uric acid level .
    I agree that many patients are stuck on a single dose of Allopurinol e.g. 300mg (or 100mg) ‘forever’ .
    I lost account how many of them I increased to 600mg or even 900mg to bring the plasma urate down towards the target of around 300 . And then it is ongoing monitoring.
    Of course , ten minute appointment with no follow up is not enough , crying out loud !

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  • Vinci Ho

    Correction
    ....my own dermatological interest ....

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  • If you throw a resource at something of course better outcomes, measured and perceived
    Wonder what ths cost effectiveness would be if measured against a well resourced GP service?

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  • IDGAF @ 5:37pm

    It's not always clear cut but often gout is just gout. Many of the patients will have had more than one episode before they see me. I will still arrange routine bloods incl urate to confirm (and exclude other causes), and bring pt in if needed.

    I'd still like to know how much time the nurses had.

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  • and were the nurses interrupted every 5 mins by reception.....

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  • How much time does the nurse have? How much does the GP have?
    We are disturbed by juniors, nurses, paramedics and patients wanting instant scripts and Med3s.

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  • Day one acute gout. Uric acid one week later.
    Uric acid 650. Not on medication. No obvious cause for secondary hyperureceamia. Give leaflet , tell what Uric acid level need to be achieved and see nurse so dose of allopurinol adjusted. That is it as far as I am concerned .
    I say to patients gout is disease of kings and king of disease. They feel elated then I add it is associated with affluence., excessive alcohol and debauchery as described in history of gout. Give naprosyn or colchicine for future attacks.

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  • if you put in on qof and pay for it it would get done. otherwise there is no time for a gp to do all of this. if nurses get 15 mins to do one problem we should have 20 mins routinely because we rarely get one problem in a consult. the system is now set up for us to fail.

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