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Efficacy and cost-effectiveness of nurse-lead care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial

Doherty, Michael; Jenkins, Wendy; Richardson, Helen; Sarmanova, Aliya; Abhishek, Abhishek; Ashton, Deborah; Barclay, Christine; Doherty, Sally; Duley, Leila; Hatton, Rachael; Rees, Frances; Stevenson, Matthew; Zhang, Weiya

Efficacy and cost-effectiveness of nurse-lead care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial Thumbnail


Authors

Michael Doherty

Wendy Jenkins

Helen Richardson

Aliya Sarmanova

Deborah Ashton

Christine Barclay

Sally Doherty

Leila Duley

Rachael Hatton

Frances Rees

Matthew Stevenson



Abstract

Background: In the UK gout management is suboptimal, only 40% of patients receiving urate-lowering therapy (ULT), usually without titration to a target serum urate (SU) level. Nurses successfully manage many diseases in primary care. This trial compared nurse-led care to usual (general practitioner-led) care for people with gout.

Methods: Research nurses were trained in best practice management of gout, including full individualised patient information and engagement in shared decision-making. Adults experiencing a gout flare in the previous year were randomised (1:1) to nurse-led or continuing usual care in the community. Assessments were at baseline, one and two years. The primary outcome was percentage of participants achieving SUA [less than] 360μmol/L at two years. Secondary outcomes were flare frequency in year two, presence of tophi, quality of life (SF-36, Gout Impact Scale) and cost per quality-adjusted life year (QALY) gained. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated based on intention to treat with multiple imputation.

Findings: Of 517 participants, 255 were assigned nurse-led care and 262 usual care. Nurse-led care associated with high uptake and adherence to ULT, and comparing nurse-led to usual care groups at two years 95% versus 30% had SU [less than] 360μmol/L (RR 3∙18, 95%CI 2∙42 to 4∙18, p [less than] 0∙0001). At two years all patient-centred clinical outcomes were statistically in favour of the nurse-led group. The cost per QALY gained for the nurse-led intervention was £5066 at two years, and modelled to be £286 at three years and cost-saving at five years.

Interpretation: Nurse-led gout care is clinically effective and cost-effective compared to usual care. These findings illustrate the benefits of patient education and engagement in gout management, and reaffirm the importance of a treat-to-target ULT strategy to improve patient-centred outcomes.

Citation

Doherty, M., Jenkins, W., Richardson, H., Sarmanova, A., Abhishek, A., Ashton, D., …Zhang, W. (2018). Efficacy and cost-effectiveness of nurse-lead care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet, 392(10156), 1403-1412. https://doi.org/10.1016/S0140-6736%2818%2932158-5

Journal Article Type Article
Acceptance Date Aug 30, 2018
Online Publication Date Oct 20, 2018
Publication Date Oct 20, 2018
Deposit Date Oct 16, 2018
Publicly Available Date Mar 28, 2024
Journal Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 392
Issue 10156
Pages 1403-1412
DOI https://doi.org/10.1016/S0140-6736%2818%2932158-5
Public URL https://nottingham-repository.worktribe.com/output/1168915
Publisher URL https://www.sciencedirect.com/science/article/pii/S0140673618321585?via%3Dihub
Additional Information This article is maintained by: Elsevier; Article Title: Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial; Journal Title: The Lancet; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/S0140-6736(18)32158-5; CrossRef DOI link to the associated document: https://doi.org/10.1016/S0140-6736(18)32415-2; Content Type: article; Copyright: © 2018 The Author(s). Published by Elsevier Ltd.

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