title: Barriers to Care in Gout: From Prescriber to Patient.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vaccher
authors.affiliation: 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.
authors.forename: Diluk R W
authors.initials: DR
authors.lastname: Kannangara
authors.affiliation: 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.
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Baysari
authors.affiliation: 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.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reath
authors.affiliation: 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.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zwar
authors.affiliation: 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.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Williams
authors.affiliation: 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. r.day@unsw.edu.au.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Day
mesh_terms: D000493:Allopurinol / Q000008:administration & dosage*; D001294:Attitude to Health; D001315:Australia; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006073:Gout / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010353:Patient Education as Topic; D063868:Patient Outcome Assessment; D010358:Patient Participation; D018570:Risk Assessment; D012720:Severity of Illness Index; D016903:Drug Monitoring
chemical_list: D000493:Allopurinol
keywords: ALLOPURINOL; EDUCATION; GOUT; MEDICATION ADHERENCE; SEMISTRUCTURED INTERVIEWS