A joint effort over a period of time: factors affecting use of urate-lowering therapy for long-term treatment of gout.
Although international guidelines encourage urate lowering therapy (ULT) for people who have more than two attacks of gout, only 30 % of patients are prescribed it and only 40 % of those adhere to the treatment. The aim was to explore reasons for this through an exploration of patient experience and understanding of ULT treatment for gout.



A qualitative study was conducted throughout the United Kingdom. Narrative and semi-structured video-recorded interviews and thematic analysis were used.



Participants talked about their views and experiences of treatment, and the factors that affected their use of ULT. The analysis revealed five main themes: 1) knowledge and understanding of gout and its treatment; 2) resistance to taking medication; 3) uncertainty about when to start ULT; 4) experiences of using ULT; and 5) desire for information and monitoring.



Patients' understanding and experiences of gout and ULT are complex and it is important for clinicians to be aware of these when working with patients. It is also important for clinicians to know that patients' perceptions and behaviour are not fixed, but can change over time, with changes to their condition, with dialogue and increased understanding. Patients want this interaction with their clinicians, through "a joint effort over a period of time".
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK. j.c.richardson@keele.ac.uk.
Jane C
JC
Richardson
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK.
Jennifer
J
Liddle
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK.
Christian D
CD
Mallen
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK.
Edward
E
Roddy
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffs., ST5 5BG, UK.
Samantha
S
Hider
Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
Suman
S
Prinjha
Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
Sue
S
Ziebland
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003299:Cooperative Behavior; D005260:Female; D006073:Gout / Q000097:blood / Q000188:drug therapy*; D006074:Gout Suppressants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D000072140:Rheumatologists / Q000523:psychology; D006113:United Kingdom; D014527:Uric Acid / Q000097:blood / Q000378:metabolism
D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol
Gout; Patient perceptions; Primary care; Qualitative; Urate lowering therapy (ULT)