Preventing Complications with Better Use of Gout Medications: Will Shared Access to Electronic Medical Records Help?
A sub study of PRECISION: Preventing Complications from Inflammatory Skin, Joint and Bowel Conditions
Study Start Date:
2015
End Date:
2019
Why Did We Do This Research?
Gout is a very painful type of arthritis that occurs when too much uric acid builds up in the body, leading to repeated inflammation and deformity in the joints. It affects over 1 million Canadians, which is expected to increase as the population ages. Studies have shown that gout often is not properly managed or patients do not stick to their treatment plan. As a result, patients often do poorly, suffering from repeated gout attacks, and complications that lead to extra hospital visits, higher costs and even death. There is little research showing how to solve this problem. In this sub-project of the PRECISION study, we evaluated an eHealth-supported, decentralized care model for gout. A team of healthcare providers—including rheumatologists, pharmacists, and dietitians- supported patients who participated. Our goal was to see if this model could help patients manage their gout more effectively, particularly in lowering their serum urate levels, and to understand patients’ experiences with this care approach. We also wanted to know how patients actually become engaged in managing their gout, from their own perspectives.
What Did We Do?
We conducted a 12-month study with 35 patients who had experienced at least one gout flare in the past year and had elevated serum urate levels. The care model involved community-based rheumatologists who provided support on an as-needed basis, monthly telephone consultations with a pharmacist, and one telephone consultation with a dietitian. These healthcare professionals were not located in the same place but had shared access to the patients’ electronic medical records (EMRs) to communicate and collaborate remotely. We measured outcomes by checking if patients reached the target serum urate level of <360 μmol/L after 12 months. We also conducted interviews with some of the patients to gather their feedback on the care model.
To explore how patients become engaged in managing their gout care, we interviewed 12 people with gout who were part of testing the new eHealth-supported care model.
What Did We Find?
We found that the EHealth care model helped patients achieve better gout management, particularly in lowering serum urate levels. Patients appreciated the better education and more personalized care they received through the coordinated use of eHealth tools and shared medical records.
We identified three main themes that explain how patients get involved in managing their gout:
1. Processing the diagnosis and management – How patients understand and come to terms with their condition and its treatment.
2. Supporting gout management – The resources, people, and strategies that help patients manage their gout.
3. Interfering with gout management – Factors that make it harder for patients to manage their condition, like challenges in accessing care or understanding their treatment.
We found that these themes are connected, and patients move between them as they navigate their journey with gout. By recognizing these stages, healthcare providers can find opportunities to better support patients and improve their management of gout.
Research Team
Project Lead:
Mary De Vera, MSc, PhD, Senior Scientist, Pharmacoepidemiology, Associate Director of Training, Arthritis Research Canada, (University of British Columbia)
For a list of team members involved in this study click here.
Alyssa Howren, MSc, PhD, Former Trainee, Arthritis Research Canada (University of British Columbia)
Nicole W. Tsao
Hyon K. Choi, MD, DrPH, FRCPC, Research Scientist, Rheumatology, Arthritis Research Canada (Harvard University)
Kam Shojania, MD, FRCPC, Clinical Trialist, Arthritis Research Canada (University of British Columbia)
Alison Kydd
Russel Friesen
Susan M. Cox
Sharan K. Rai, MSc, PhD, Postdoctoral Fellow, Trainee, Arthritis Research Canada (Harvard University)
J. Antonio Avina-Zubieta, MD, MSc, PhD, FRCPC, Senior Scientist, Arthritis Research Canada (University of British Columbia)
Funding Agencies
- Canadian Institute for Health Research
- Crohn’s and Colitis Canada
- Canadian Initiative for Outcomes in Rheumatology cAre (CIORA)
Related Publications
- Howren A, Tsao NW, Choi HK, et al. eHealth-supported decentralized multi-disciplinary care for gout involving rheumatology, pharmacy, and dietetics: proof-of-concept study. Clin Rheumatol. 2020;39(4):1241-1249. doi:10.1007/s10067-019-04809-6
- Howren A, Cox SM, Shojania K, Rai SK, Choi HK, De Vera MA. How patients with gout become engaged in disease management: a constructivist grounded theory study. Arthritis Res Ther. 2018;20(1):110. Published 2018 Jun 1. doi:10.1186/s13075-018-1608-x
- https://www.arthritisresearch.ca/wp-content/uploads/BRIDGE.pdf