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Joint Bone Spine
Volume 86, n° 3
pages 357-362 (mai 2019)
Doi : 10.1016/j.jbspin.2018.10.008
accepted : 17 October 2018
Original Articles

Implication of nurse intervention on engagement with urate-lowering drugs: A qualitative study of participants in a RCT of nurse led care

Zahira P. Latif a, b, Georgina Nakafero a, c, Wendy Jenkins a, c, Michael Doherty a, c, Abhishek Abhishek a, c,
a Academic rheumatology, faculty of medicine & health sciences, school of medicine, university of Nottingham, Nottingham, UK 
b Rheumatology research group, institute of inflammation and ageing, university of Birmingham, Birmingham, UK 
c Nottingham NIHR biomedical research centre, Nottingham, UK 

Corresponding author at: Academic rheumatology, faculty of medicine & health sciences, school of medicine, university of Nottingham, Nottingham, UK.Academic rheumatologyfaculty of medicine & health sciencesschool of medicineuniversity of NottinghamNottinghamUK

To explore patient perception of the role of a nurse-led complex package of care in facilitating engagement with urate-lowering therapies (ULTs) in the management of gout.


Thirty people who had participated in a randomised controlled trial investigating the effect of a nurse-led complex package of care for gout, were purposively sampled and interviewed between 18–26 months after the end of the trial. Interviews were recorded, transcribed and analysed using a modified grounded-theory approach. Data were managed using Nvivo. STATA v15 was used to describe summary statistics.


Participants described their views and experiences of engaging with a nurse-led intervention designed to provide holistic assessment, individualised patient education, and involvement in shared decision-making for the long-term management of gout. The analysis revealed key themes in how nurse-led intervention facilitated engagement with ULT, namely by proving improved knowledge and understanding of gout and its treatment, involvement of patients in decision-making about treatment, and increased confidence about benefits from treatment. However, some treatment uncertainty and concern remained and one participant free of gout flares discontinued ULT, while another halved the dose after the end of the trial.


This study reports data on patient experience of engaging with ULT to manage gout after receiving nurse-led care. It demonstrates that shared decision-making and the joint efforts of fully informed practitioners and patients persuades patients to engage with ULTs, and that experiencing the benefits of curative treatment motivates them to maintain adherence.

The full text of this article is available in PDF format.

Keywords : Urate-lowering therapy, Gout, Nurse-led intervention, Medication adherence, Clinical inertia, Therapeutic education

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