Abstract
IntroductionLimited literature exists for qualitative studies of medication adherence in gout, especially in African-Americans. The aim of this study was to examine the facilitators and barriers to adherence to urate-lowering therapy (ULT) in African-Americans with gout.MethodsIn this study, nine nominal groups lasting 1 to 1.5 hours each were conducted in African-Americans with gout, six with low ULT and three with high ULT adherence (medication possession ratios of <0.80 or ≥0.80, respectively). Patients presented, discussed, combined and rank ordered their concerns. A qualitative analysis was performed.ResultsThis study included 43 patients with mean age 63.9 years (standard deviation, 9.9), 67% men, who participated in nine nominal groups (seven in men, two in women): African-American men (n = 30); African-American women (n = 13). The main facilitators to ULT adherence (three groups) were the recognition of the need to take ULT regularly to prevent gout flares, prevent pain from becoming chronic/severe and to have less dietary restriction; the lack of side effects from ULT; trust in physicians; and avoiding the need to seek emergent/urgent care for flares. Patients achieved high ULT adherence by organizing their pills using the pillbox and the incorporation of ULT intake into their routine to prevent forgetting. The main barriers to optimal ULT adherence were (six groups): doubts about effectiveness of ULT, concerns about cost and side effects, concomitant medications, forgetfulness, refilling the prescriptions on time, pill size and difficulty in swallowing, competing priorities, patient preference for alternative medicines (that is, cherry juice) and frequent travel.ConclusionsIdentification of facilitators and barriers to high ULT adherence in African-Americans with gout in this study lays the foundation for designing interventions to improve ULT adherence in racial minorities.
Highlights
Limited literature exists for qualitative studies of medication adherence in gout, especially in African-Americans
Principles of appropriate longterm gout management include the appropriate use of urate-lowering therapy (ULT) to keep serum urate at or below 6 mg/dl and to treat acute gout flares with short-term anti-inflammatory drugs such as corticosteroids, colchicine or non-steroidal anti-inflammatory drugs (NSAIDs)
Two recent qualitative studies of semi-structured interviews with 26 US Caucasian patients with gout and 20 UK Caucasian gout patients (15 men, 5 women) found that gout patients reported non-adherence with allopurinol and cited several reasons, such as financial concerns, forgetfulness and doubts about the benefits of long-term treatment [15,16]. Both studies were done in Caucasian men, covered a broad array of topics ranging from the gout treatment to quality of life to patient knowledge and so on with relatively little focus on medication adherence, which is a key challenge in gout management [9,13]
Summary
Limited literature exists for qualitative studies of medication adherence in gout, especially in African-Americans. Two recent qualitative studies of semi-structured interviews with 26 US Caucasian patients with gout and 20 UK Caucasian gout patients (15 men, 5 women) found that gout patients reported non-adherence with allopurinol and cited several reasons, such as financial concerns, forgetfulness and doubts about the benefits of long-term treatment [15,16]. Both studies were done in Caucasian men, covered a broad array of topics ranging from the gout treatment to quality of life to patient knowledge and so on with relatively little focus on medication adherence, which is a key challenge in gout management [9,13]. Two large knowledge gaps exist in qualitative studies in medication adherence in gout, since none of the previous studies: (1) recruited gout patients with high medication adherence or stratified patients by medication adherence (for example, medication possession ratio); and (2) recruited racial minorities
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