Skip to main content
Top
Published in: BMC Primary Care 1/2016

Open Access 01-12-2016 | Research article

“It’s complicated” - talking about gout medicines in primary care consultations: a qualitative study

Authors: Caroline Morris, Lindsay Macdonald, Maria Stubbe, Anthony Dowell

Published in: BMC Primary Care | Issue 1/2016

Login to get access

Abstract

Background

Gout is the most common form of inflammatory arthritis. It is associated with substantial co-morbidity and often managed in primary care. A greater understanding of the communication process between patients and healthcare professionals provides one way of improving the management of this condition. This paper describes communication about gout medicines and treatment between patients and primary care health professionals during routine consultations.

Methods

Video-recordings of 31 individual healthcare consultations between patients and a range of primary care practitioners (general practitioners, practice nurses, podiatrists, dietitians) from an archived database were reviewed. Consultations that encompassed any discussion about gout medicines and treatment were included (n = 27) and were not solely restricted to those where gout was the presenting complaint. Themes were derived from an inductive qualitative analysis, from clinical and linguistic perspectives, based on the conversation between patients and practitioners about medicines and visual observation of these interactions.

Results

A number of factors were identified that had the potential to impact on the optimal management of gout in primary care. These included level of patient knowledge, patient attitudes to medicines, and the attributes of practitioner communication with patients. The latter related to the style of delivery and content of the information provided, and the ability of practitioners to make use of opportunities that arose to discuss these issues.

Conclusions

Patients with gout communicate at varying levels of complexity with a diverse range of primary care healthcare professionals about the treatment of their condition. It is important that all practitioners engaging with gout patients in this setting are knowledgeable about the current management of gout, provide clear, consistent and accurate messages, remain aware that these messages may need repeating over time, and are supportive of patients’ medicine-taking preferences.
Literature
2.
go back to reference Kuo C-F, See L-C, Luo S-F, Ko Y-S, Lin Y-S, Hwang J-S, et al. Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology. 2010;49:141–6.CrossRefPubMed Kuo C-F, See L-C, Luo S-F, Ko Y-S, Lin Y-S, Hwang J-S, et al. Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology. 2010;49:141–6.CrossRefPubMed
3.
go back to reference Kuo C-F, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015;74:661–7 Kuo C-F, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015;74:661–7
5.
go back to reference Anon. An update on the management of gout. Best Pract J. 2013;51:8–14. Anon. An update on the management of gout. Best Pract J. 2013;51:8–14.
6.
go back to reference Jordan KM, Cameron JS, Snaith M, Zhang W, Doherty M, Seckl J, et al. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout. Rheumatology. 2007;46(8):1372–4.CrossRefPubMed Jordan KM, Cameron JS, Snaith M, Zhang W, Doherty M, Seckl J, et al. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout. Rheumatology. 2007;46(8):1372–4.CrossRefPubMed
7.
go back to reference Zhang W, Doherty M, Bardin T, Pascual E, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65:1312–24.CrossRefPubMedPubMedCentral Zhang W, Doherty M, Bardin T, Pascual E, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65:1312–24.CrossRefPubMedPubMedCentral
8.
go back to reference Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64:1431–46.CrossRef Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64:1431–46.CrossRef
10.
go back to reference Mikuls TR, Farrar JT, Bilker WB, Fernandes S, Saag KG. Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD). Rheumatology. 2005;44:1038–42.CrossRefPubMed Mikuls TR, Farrar JT, Bilker WB, Fernandes S, Saag KG. Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD). Rheumatology. 2005;44:1038–42.CrossRefPubMed
11.
go back to reference Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis. 2008;67:960–6.CrossRefPubMed Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis. 2008;67:960–6.CrossRefPubMed
12.
go back to reference Singh JA, Hodges JS, Toscano JP, Asch SM. Quality of care for gout in the US needs improvement. Arthritis Care Res. 2007;57:822–9.CrossRef Singh JA, Hodges JS, Toscano JP, Asch SM. Quality of care for gout in the US needs improvement. Arthritis Care Res. 2007;57:822–9.CrossRef
13.
go back to reference Kuo C-F, Grainge MJ, Mallen C, Zhang W, Doherty M. Eligibility for and prescription of urate-lowering treatment in patients with incident gout in England. JAMA. 2014;312:2684–6.CrossRefPubMed Kuo C-F, Grainge MJ, Mallen C, Zhang W, Doherty M. Eligibility for and prescription of urate-lowering treatment in patients with incident gout in England. JAMA. 2014;312:2684–6.CrossRefPubMed
14.
go back to reference Roddy E, Zhang W, Doherty M. Concordance of the management of chronic gout in a UK primary care population with the EULAR gout recommendations. Ann Rheum Dis. 2007;66:1311–5.CrossRefPubMedPubMedCentral Roddy E, Zhang W, Doherty M. Concordance of the management of chronic gout in a UK primary care population with the EULAR gout recommendations. Ann Rheum Dis. 2007;66:1311–5.CrossRefPubMedPubMedCentral
15.
go back to reference Harrold LR, Mazor KM, Negron A, Ogarek J, Firneno C, Yood RA. Primary care providers’ knowledge, beliefs and treatment practices for gout: Results of a physician questionnaire. Rheumatology. 2013;52:1623–9.CrossRefPubMedPubMedCentral Harrold LR, Mazor KM, Negron A, Ogarek J, Firneno C, Yood RA. Primary care providers’ knowledge, beliefs and treatment practices for gout: Results of a physician questionnaire. Rheumatology. 2013;52:1623–9.CrossRefPubMedPubMedCentral
16.
go back to reference Dalbeth N. Management of gout in primary care: challenges and potential solutions. Rheumatology. 2013;52:1549–50.CrossRefPubMed Dalbeth N. Management of gout in primary care: challenges and potential solutions. Rheumatology. 2013;52:1549–50.CrossRefPubMed
17.
go back to reference Richardson JC, Liddle J, Mallen CD, Roddy E, Prinjha S, Ziebland S, et al. “Why me? I don’t fit the mould… I am a freak of nature”: a qualitative study of women’s experience of gout. BMC Womens Health. 2015; doi:10.1186/s12905-015-0277-z Richardson JC, Liddle J, Mallen CD, Roddy E, Prinjha S, Ziebland S, et al. “Why me? I don’t fit the mould… I am a freak of nature”: a qualitative study of women’s experience of gout. BMC Womens Health. 2015; doi:10.​1186/​s12905-015-0277-z
19.
go back to reference Martini N, Bryant L, Karu LT, Aho L, Chan R, Miao J, et al. Living with gout in New Zealand: An exploratory study into people’s knowledge about the disease and its treatment. J Clin Rheumatol. 2012;18:125–9.CrossRefPubMed Martini N, Bryant L, Karu LT, Aho L, Chan R, Miao J, et al. Living with gout in New Zealand: An exploratory study into people’s knowledge about the disease and its treatment. J Clin Rheumatol. 2012;18:125–9.CrossRefPubMed
20.
go back to reference Te Karu L, Bryant L, Elley CR. Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study. J Prim Health Care. 2013;5:214–22. Te Karu L, Bryant L, Elley CR. Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study. J Prim Health Care. 2013;5:214–22.
21.
go back to reference Spencer K, Carr A, Doherty M. Patient and provider barriers to effective management of gout in general practice: A qualitative study. Ann Rheum Dis. 2012;71:1490–5.CrossRefPubMed Spencer K, Carr A, Doherty M. Patient and provider barriers to effective management of gout in general practice: A qualitative study. Ann Rheum Dis. 2012;71:1490–5.CrossRefPubMed
22.
go back to reference Lindsay K, Gow P, Vanderpyl J, Logo P, Dalbeth N. The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. J Clin Rheumatol. 2011;17:1–6.CrossRefPubMed Lindsay K, Gow P, Vanderpyl J, Logo P, Dalbeth N. The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. J Clin Rheumatol. 2011;17:1–6.CrossRefPubMed
23.
go back to reference Harrold LR, Mazor KM, Velten S, Ockene IS, Yood RA. Patients and providers view gout differently: a qualitative study. Chronic Ill. 2010;6:263–71.CrossRef Harrold LR, Mazor KM, Velten S, Ockene IS, Yood RA. Patients and providers view gout differently: a qualitative study. Chronic Ill. 2010;6:263–71.CrossRef
25.
go back to reference Boyatzis R. Thematic Analysis and Code Development: Transforming Qualitative Information. London: Sage Publications; 1998. Boyatzis R. Thematic Analysis and Code Development: Transforming Qualitative Information. London: Sage Publications; 1998.
26.
go back to reference Street Jr RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns. 2009;74:295–301.CrossRefPubMed Street Jr RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns. 2009;74:295–301.CrossRefPubMed
27.
go back to reference Dowell A, Macdonald L, Stubbe M, Plumridge E, Dew K. Clinicians at work: What can we learn from interactions in the consultation? N Z Fam Physician. 2007;34:345–50. Dowell A, Macdonald L, Stubbe M, Plumridge E, Dew K. Clinicians at work: What can we learn from interactions in the consultation? N Z Fam Physician. 2007;34:345–50.
28.
go back to reference Harrold L, Mazor K, Peterson D, Naz N, Firneno C, Yood R. Patients’ knowledge and beliefs concerning gout and its treatment: a population based study. BMC Musculoskelet Disord. 2012. doi:10.1186/1471-2474-13-180. Harrold L, Mazor K, Peterson D, Naz N, Firneno C, Yood R. Patients’ knowledge and beliefs concerning gout and its treatment: a population based study. BMC Musculoskelet Disord. 2012. doi:10.​1186/​1471-2474-13-180.
29.
go back to reference Stevenson FA, Cox K, Britten N, Dundar Y. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect. 2004;7:235–45.CrossRefPubMed Stevenson FA, Cox K, Britten N, Dundar Y. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect. 2004;7:235–45.CrossRefPubMed
30.
go back to reference Politi MC, Dizon DS, Frosch DL, Kuzemchak MD, Stiggelbout AM. Importance of clarifying patients’ desired role in shared decision making to match their level of engagement with their preferences. Br Med J. 2013. doi:10.1136/bmj.f7066. Politi MC, Dizon DS, Frosch DL, Kuzemchak MD, Stiggelbout AM. Importance of clarifying patients’ desired role in shared decision making to match their level of engagement with their preferences. Br Med J. 2013. doi:10.​1136/​bmj.​f7066.
31.
go back to reference Paskins Z, Sanders T, Croft PR, Hassell AB. The identity crisis of osteoarthritis in general practice: a qualitative study using video-stimulated recall. Ann Fam Med. 2015;13:537–44.CrossRefPubMedPubMedCentral Paskins Z, Sanders T, Croft PR, Hassell AB. The identity crisis of osteoarthritis in general practice: a qualitative study using video-stimulated recall. Ann Fam Med. 2015;13:537–44.CrossRefPubMedPubMedCentral
Metadata
Title
“It’s complicated” - talking about gout medicines in primary care consultations: a qualitative study
Authors
Caroline Morris
Lindsay Macdonald
Maria Stubbe
Anthony Dowell
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2016
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-016-0515-y

Other articles of this Issue 1/2016

BMC Primary Care 1/2016 Go to the issue