Rai Sharan K, Choi Hyon K, Choi Sally H J, Townsend Anne F, Shojania Kam, De Vera Mary A
Arthritis Research Canada, Vancouver, BC, Canada.
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Rheumatology (Oxford). 2018 Jul 1;57(7):1282-1292. doi: 10.1093/rheumatology/kex530.
Gout care remains highly suboptimal, contributing to an increased global disease burden. To understand barriers to gout care, our aim was to provide a systematic review and thematic synthesis of qualitative studies worldwide reporting provider and patient perspectives and experiences with management.
We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies of provider and patient perspectives on gout management. We used thematic synthesis to combine the included studies and identify key themes across studies.
We included 20 studies that reported the experiences and perspectives of 480 gout patients and 120 providers spanning five different countries across three continents. We identified three predominant provider themes: knowledge gaps and management approaches; perceptions and beliefs about gout patients; and system barriers to optimal gout care (e.g. time constraints and a lack of incentives). We also identified four predominant themes among gout patients: limited gout knowledge; interactions with health-care providers; attitudes towards and experiences with taking medication; and practical barriers to long-term medication use.
Our systematic review of worldwide literature consistently identified gaps in gout knowledge among providers, which is likely to contribute to patients' lack of appropriate education about the fundamental causes of and essential treatment approaches for gout. Furthermore, system barriers among providers and day-to-day challenges of taking long-term medications among patients are considerable. These factors provide key targets to improve the widespread suboptimal gout care.
痛风护理仍极不理想，导致全球疾病负担增加。为了解痛风护理的障碍，我们旨在对全球范围内报告医护人员和患者对痛风管理的观点及经历的定性研究进行系统综述和主题综合分析。
我们对MEDLINE、EMBASE、护理学与健康相关学科累积索引以及社会科学引文索引数据库进行了全面检索，并选取了关于医护人员和患者对痛风管理观点的定性研究。我们运用主题综合分析来整合纳入的研究，并确定各项研究中的关键主题。
我们纳入了20项研究，这些研究报告了来自三大洲五个不同国家的480名痛风患者和120名医护人员的经历与观点。我们确定了医护人员的三个主要主题：知识差距与管理方法；对痛风患者的看法和信念；以及优化痛风护理的系统障碍（如时间限制和缺乏激励措施）。我们还确定了痛风患者中的四个主要主题：痛风知识有限；与医护人员的互动；对服药的态度和经历；以及长期用药的实际障碍。
我们对全球文献的系统综述一致发现医护人员在痛风知识方面存在差距，这可能导致患者缺乏关于痛风根本病因和基本治疗方法的适当教育。此外，医护人员面临的系统障碍以及患者长期服药面临的日常挑战相当大。这些因素为改善普遍存在的不理想痛风护理提供了关键目标。
