Gill Iqbal, Dalbeth Nicola, 'Ofanoa Malakai, Goodyear-Smith Felicity
Faculty of Medical & Health Science, University of Auckland, Auckland, New Zealand.
Bone and Joint Research Group, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.
BJGP Open. 2020 Aug 25;4(3). doi: 10.3399/bjgpopen20X101051. Print 2020 Aug.
Gout treatment is suboptimal despite available therapy, with low levels of initiation and persistence of urate-lowering therapy (ULT) in many patients.
To identify all interventions that have attempted to improve the uptake of ULT and analyse the clinical outcomes.
DESIGN & SETTING: A systematic review of international articles published in English.
A systematic search was conducted through MEDLINE, Embase, CINAHL Plus, and Scopus databases to identify all studies on relevant interventions for gout. Interventions were included if they aimed to address patient adherence with serum urate (SU) level as an outcome. This included patient education, practitioner monitoring, medication titration, SU monitoring, and ongoing patient engagement and follow-up. Follow-up studies to original interventions and those with only an abstract available were included.
Twenty articles met the inclusion criteria, describing outcomes of 18 interventions conducted in primary care settings: six nurse-led, five pharmacist-led, and seven multidisciplinary, multifaceted interventions. Improvement in SU levels was observed in all interventions. Nurse-led interventions were effective at empowering patients as they addressed illness perceptions and provided education, advice, and telephone follow-up. Pharmacist-led interventions primarily aimed to monitor patients, alter medication dosage, and provide automated telephone follow-up. Various multifaceted programmes involving a range of providers resulted in increased sustained use of urate-lowering medication.
A nurse-led approach focusing on patient understanding about gout is the most effective in achieving improved patient adherence, and lowered SU levels among patients. An intervention should include patient education and follow-up components.
尽管有可用的治疗方法，但痛风治疗效果仍不理想，许多患者的降尿酸治疗（ULT）起始率和持续率较低。
确定所有试图提高ULT使用率的干预措施，并分析临床结果。
对以英文发表的国际文章进行系统综述。
通过MEDLINE、Embase、CINAHL Plus和Scopus数据库进行系统检索，以确定所有关于痛风相关干预措施的研究。如果干预措施旨在以血清尿酸（SU）水平作为结果来解决患者依从性问题，则纳入该干预措施。这包括患者教育、医生监测、药物滴定、SU监测以及持续的患者参与和随访。纳入对原始干预措施的随访研究以及那些只有摘要可用的研究。
20篇文章符合纳入标准，描述了在初级保健机构中进行的18项干预措施的结果：6项由护士主导，5项由药剂师主导，7项多学科、多方面的干预措施。所有干预措施均观察到SU水平有所改善。由护士主导的干预措施在增强患者能力方面是有效的，因为它们解决了患者对疾病的认知，并提供了教育、建议和电话随访。由药剂师主导的干预措施主要旨在监测患者、改变药物剂量并提供自动电话随访。各种涉及一系列提供者的多方面项目导致降尿酸药物的持续使用增加。
以护士为主导、注重患者对痛风的理解的方法在提高患者依从性和降低患者SU水平方面最为有效。一项干预措施应包括患者教育和随访部分。
