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October 19, 2018
In a UK study, nurse-led care focusing on education and patient engagement significantly improved the proportion of gout sufferers who achieved serum urate target levels.
According to a new study, nurse-led gout care and partly involving education and patient engagement can dramatically increase adherence to treatment reducing urate rate and the probability of reaching serum urate target levels.
British investigators randomly assigned 517 patients who had had a gout attack in the last 12 months, to receive either nurse-led care (255 patients) or usual care provided by a physician (262 patients). The primary endpoint was the proportion of patients who achieved a serum urate target level of less than 6 mg / dL at 2 years. Nurses participating in the study received training on gout and its management. The nurses provided patients with an overall assessment, a discussion of perceptions of the disease and comprehensive information on gout, and encouraged patients to participate in decision-making.
The results showed that 94.9% of patients in the nurse-led care group had reached the serum urate target at 2 years, compared to 29.7% of usual care patients, Michael Doherty, MD , from the University of Nottingham in Nottingham, UK. colleagues reported in The lancet. Care provided by the nursing staff was associated with a probability three times greater to reach the target serum urate than usual care.
Initially, the nurse-led care group and the usual care group had similar proportions of patients taking cholesterol-lowering therapy (39.6% vs. 38.9%). At age 2, however, the nurse-led care group, compared to the usual care group, had a significantly higher proportion of patients taking urine-lowering treatment (96.1% vs. 56.1%). %).
Initially, approximately 80% of both groups had at least two gout attacks in the previous 12 months. The nurse-led care group, compared with the usual care group, had a significantly lower proportion of patients with 2 or more relapses in the second year (8.0% vs. 24.2%).
"Our results highlight the importance and success of individualized patient education and care, which should be considered by any healthcare professional who cares for people with gout." concluded the authors.
With respect to the limitations of the study, Dr. Doherty's team noted that recruitment may have been subject to selection bias if participating firms were interested in gout. Similarly, if patients concerned about gout were more likely to participate, the study population might have been prone to a response bias.
In an accompanying editorial, Tuhina Neogi, MD, Ph.D., of the Faculty of Medicine at Boston University, and Nicola Dalbeth, MBChB, MD, of the University of Boston, said: Auckland, New Zealand, said Dr. Doherty and his colleagues "show the way forward for improving gout outcomes, demonstrating a continuum of care leading to sustained adherence and clinical benefits through individualized education." focusing on the central concept of gout as a chronic disease of urate crystal deposition and through a proactive, well-tolerated approach to targeted therapy. "
References
Doherty, M., Jenkins, W., Richardson, et al. Efficacy and cost-effectiveness of nurse-led care involving patient education and involvement, and a strategy to reduce the number of treatment-related ulatations compared to usual care of gout: a controlled trial randomized. Lancet. 2018; 392: 1403-1412.
Neogi T, Dalbeth N. Patient education and commitment in the treatment of gout to treat the target. Lancet. 2018; 392: 1379-1380.
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