Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.
Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.
Lancet. 2018 Oct 20;392(10156):1403-1412. doi: 10.1016/S0140-6736(18)32158-5.
In the UK, gout management is suboptimum, with only 40% of patients receiving urate-lowering therapy, usually without titration to achieve a target serum urate concentration. Nurses successfully manage many diseases in primary care. We compared nurse-led gout care to usual care led by general practitioners (GPs) for people in the community.
Research nurses were trained in best practice management of gout, including providing individualised information and engaging patients in shared decision making. Adults who had experienced a gout flare in the previous 12 months were randomly assigned 1:1 to receive nurse-led care or continue with GP-led usual care. We assessed patients at baseline and after 1 and 2 years. The primary outcome was the percentage of participants who achieved serum urate concentrations less than 360 μmol/L (6 mg/dL) at 2 years. Secondary outcomes were flare frequency in year 2, presence of tophi, quality of life, and cost per quality-adjusted life-year (QALY) gained. Risk ratios (RRs) and 95% CIs were calculated based on intention to treat with multiple imputation. This study is registered with www.ClinicalTrials.gov, number NCT01477346.
517 patients were enrolled, of whom 255 were assigned nurse-led care and 262 usual care. Nurse-led care was associated with high uptake of and adherence to urate-lowering therapy. More patients receiving nurse-led care had serum urate concentrations less than 360 μmol/L at 2 years than those receiving usual care (95% vs 30%, RR 3·18, 95% CI 2·42-4·18, p<0·0001). At 2 years all secondary outcomes favoured the nurse-led group. The cost per QALY gained for the nurse-led intervention was £5066 at 2 years.
Nurse-led gout care is efficacious and cost-effective compared with usual care. Our findings illustrate the benefits of educating and engaging patients in gout management and reaffirm the importance of a treat-to-target urate-lowering treatment strategy to improve patient-centred outcomes.
Arthritis Research UK.
在英国，痛风管理并不理想，只有 40%的患者接受降尿酸治疗，通常没有滴定以达到目标血清尿酸浓度。护士在初级保健中成功管理许多疾病。我们比较了社区中护士主导的痛风护理与普通医生（GP）主导的常规护理。
研究护士接受了痛风最佳实践管理方面的培训，包括提供个性化信息并让患者参与共同决策。在过去 12 个月内经历过痛风发作的成年人被随机分配 1:1 接受护士主导的护理或继续接受 GP 主导的常规护理。我们在基线、1 年和 2 年时评估了患者。主要结局是 2 年内达到血清尿酸浓度<360 μmol/L（6 mg/dL）的参与者百分比。次要结局是 2 年内的发作频率、痛风石的存在、生活质量和每获得一个质量调整生命年（QALY）的成本。基于意向治疗进行风险比（RR）和 95%CI 计算，并进行多次插补。本研究在 www.ClinicalTrials.gov 注册，编号为 NCT01477346。
共纳入 517 例患者，其中 255 例接受护士主导的护理，262 例接受常规护理。护士主导的护理与降尿酸治疗的高使用率和高依从性相关。接受护士主导护理的患者在 2 年内达到血清尿酸浓度<360 μmol/L 的比例高于接受常规护理的患者（95%比 30%，RR 3.18，95%CI 2.42-4.18，p<0.0001）。在 2 年时，所有次要结局均有利于护士主导的组。护士主导干预的每获得一个 QALY 的成本为 2 年 5066 英镑。
与常规护理相比，护士主导的痛风护理是有效的且具有成本效益。我们的发现表明，教育和让患者参与痛风管理可以带来益处，并再次强调了以目标为导向的降尿酸治疗策略对于改善以患者为中心的结局的重要性。
英国关节炎研究。
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