3
|
Pisaniello HL, Lester S, Gonzalez-Chica D, Stocks N, Longo M, Sharplin GR, Dal Grande E, Gill TK, Whittle SL, Hill CL. Gout prevalence and predictors of urate-lowering therapy use: results from a population-based study. Arthritis Res Ther 2018; 20:143. [PMID: 29996922 PMCID: PMC6042461 DOI: 10.1186/s13075-018-1633-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/25/2018] [Indexed: 12/27/2022] Open
Abstract
Background Gout has an increasing global prevalence. Underutilization of urate-lowering therapy (ULT) is thought to be common, via both suboptimal dosing and poor medication adherence. The aims of this study were to determine the prevalence of self-reported gout and the key predictors of ULT use in those with gout in a representative population survey in South Australia. Methods Data were obtained from the Spring 2015 South Australian Health Omnibus Survey, a multilevel, systematic, survey in a representative population sample involving face-to-face interviews (n = 3005). This study analyzed responses from respondents aged ≥ 25 years (n = 2531) about self-reported gout, ULT use, sociodemographic factors, lifestyle factors, and comorbidities, using survey weighting. Univariate and subsequent adjusted logistic regression analyses on self-reported gout were performed. ULT use was divided into three categories (never use, prior use, and current use) and these data were analyzed using a multinomial logistic regression model. Results Self-reported gout prevalence was 6.8% (95% CI 5.8, 7.9). The mean age of respondents with gout was 64 years (standard deviation 16) and 82% were male. As expected, older age, male gender, lower socioeconomic status (SES), and higher body mass index (BMI) were associated with gout, as were high alcohol consumption, current smoking, other forms of arthritis, and hypertension or hypercholesterolemia medication, after adjustment for sociodemographic variables. Two thirds of respondents with gout reported ULT use (36% current; 29% previous) with only 55% continuing treatment. Predictors of ULT use included male gender, low SES, and concomitant cholesterol-lowering therapy. Respondents with gout with a higher BMI were more likely to remain on ULT. Conclusions Despite gout being a common, potentially disabling joint disease, only 55% of respondents with gout in this study adhered to ULT. Identification of key predictors of ULT use will provide guidance on prescribing strategy in clinical practice and on the quality of gout care in the community. Electronic supplementary material The online version of this article (10.1186/s13075-018-1633-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Huai Leng Pisaniello
- Department of Rheumatology, The Queen Elizabeth Hospital, Woodville South, Australia.
| | - Susan Lester
- Department of Rheumatology, The Queen Elizabeth Hospital, Woodville South, Australia.,Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Marie Longo
- Drug and Alcohol Services South Australia, Stepney, Australia
| | - Greg R Sharplin
- Behavioural Research and Evaluation Unit, Cancer Council South Australia, Eastwood, Australia
| | - Eleonora Dal Grande
- Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Tiffany K Gill
- Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Samuel L Whittle
- Department of Rheumatology, The Queen Elizabeth Hospital, Woodville South, Australia.,Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Catherine L Hill
- Department of Rheumatology, The Queen Elizabeth Hospital, Woodville South, Australia.,Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
4
|
Vaccher S, Kannangara DRW, Baysari MT, Reath J, Zwar N, Williams KM, Day RO. Barriers to Care in Gout: From Prescriber to Patient. J Rheumatol 2015; 43:144-9. [PMID: 26568590 DOI: 10.3899/jrheum.150607] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To explore the understanding of gout and its management by patients and general practitioners (GP), and to identify barriers to optimal gout care. METHODS Semistructured interviews were conducted with 15 GP and 22 patients in Sydney, Australia. Discussions were focused on medication adherence, experiences with gout, and education and perceptions around interventions for gout. Interviews were audio recorded, transcribed verbatim, and analyzed for themes using an analytical framework. RESULTS Adherence to urate-lowering medications was identified as problematic by GP, but less so by patients with gout. However, patients had little appreciation of the risk of acute attacks related to variable adherence. Patients felt stigmatized that their gout diagnosis was predominantly related to perceptions that alcohol and dietary excess were causal. Patients felt they did not have enough education about gout and how to manage it. A manifestation of this was that uric acid concentrations were infrequently measured. GP were concerned that they did not know enough about managing gout and most were not familiar with current guidelines for management. For example and importantly, the strategies for reducing the risk of acute attacks when commencing urate-lowering therapy (ULT) were not well appreciated by GP or patients. CONCLUSION Patients and GP wished to know more about gout and its management. Greater success in establishing and maintaining ULT will require further and better education to substantially benefit patients. Also, given the prevalence, and personal and societal significance of gout, innovative approaches to transforming the management of this eminently treatable disease are needed.
Collapse
Affiliation(s)
- Stefanie Vaccher
- From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW
| | - Diluk R W Kannangara
- From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW
| | - Melissa T Baysari
- From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW
| | - Jennifer Reath
- From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW
| | - Nicholas Zwar
- From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW
| | - Kenneth M Williams
- From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW
| | - Richard O Day
- From the School of Medical Sciences, and School of Public Health and Community Medicine, and St. Vincent's Clinical School, University of New South Wales (UNSW); Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; School of Medicine, University of Western Sydney, Sydney, Australia.S. Vaccher, BSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; D.R. Kannangara, BMedSc (Hons), School of Medical Sciences, UNSW, and Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; M.T. Baysari, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University; J. Reath, MBBS, MMed, FRACGP, School of Medicine, University of Western Sydney; N. Zwar, MBBS, MPH, PhD, FRACGP, School of Public Health and Community Medicine, UNSW; K.M. Williams, PhD, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital; R.O. Day, MBBS, MD, FRACP, Department of Clinical Pharmacology & Toxicology, St. Vincent's Hospital, and St. Vincent's Clinical School, UNSW.
| |
Collapse
|