title: A qualitative study to explore health professionals' experience of treating gout: understanding perceived barriers to effective gout management.
abstract: INTRODUCTION The management of gout is challenging and mainly occurs in primary care. This study aims to explore the experience of treating gout among primary care clinicians and understand the perceived barriers to effective therapy. METHODS Fourteen health professionals from primary care practices in South Auckland were recruited. Each participated in a semi-structured interview exploring their experience of treating and managing gout patients were analysed thematically. FINDINGS Participants described the large burden of gout in their communities and the importance of the clinician-patient relationship in gout management. Four themes summarise the perceived barriers to effective urate lowering therapy (ULT); unique gout factors, eg its intermittent nature and potential for stigmatisation; systemic barriers to optimal treatment, or barriers that emerge from working within a certain organisation; uncertainty about ownership, or who should carry responsibility for overcoming barriers to optimal treatment; and cultural barriers to optimal treatment. CONCLUSION Clinicians in primary practice perceive gout management to be mainly acute rather than preventive care. Patients may be stigmatised and management difficult particularly when diet is emphasised over ULT. Practice nurses are a group potentially available and willing to assist in educating patients. These findings may be helpful in planning for and improving healthcare in gout. KEYWORDS Gout; general practice; uric acid; primary health care; allopurinol; primary prevention.
authors.affiliation: Medical student, University of Auckland.
authors.forename: Chloe
authors.initials: C
authors.lastname: Humphrey
authors.affiliation: East Tamaki Healthcare.
authors.forename: Richard
authors.initials: R
authors.lastname: Hulme
authors.affiliation: Department of Medicine, University of Auckland.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
authors.affiliation: Department of Rheumatology, Counties Manukau District Health Board.
authors.forename: Peter
authors.initials: P
authors.lastname: Gow
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland.
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
authors.affiliation: Department of Rheumatology, Auckland District Health Board.
authors.forename: Karen
authors.initials: K
authors.lastname: Lindsay
mesh_terms: D003469:Culture; D004032:Diet; D006073:Gout / Q000188:drug therapy* / Q000523:psychology* / Q000628:therapy; D006074:Gout Suppressants / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008019:Life Style; D010353:Patient Education as Topic; D010465:Perception; D011320:Primary Health Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D057545:Social Stigma; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid