In patients with gout who have an indication for uric acid lowering, nurse-based management places more patients at target levels and might improve outcomes relative to usual physician-based care.
"Our study provides evidence that nurse-led therapy for gout leads to better uric acid control, which is an important consideration with the increasing incidence and the increasing costs of managing this condition," said Jesper W. Larsen, a registered nurse affiliated with the Department of Rheumatology at North Denmark Regional Hospital, Hjørring, Denmark. He presented the study at theThe advantage of nurse-led care was seen across every subgroup evaluated.
Of 186 patients treated after nurse-led care was implemented, 72 were transitioned to usual care, and the remaining 114 continued receiving nurse-led care over the next 2 years of follow-up. In the nurse-led care arm, nurses who specialized in rheumatology and were trained in gout management monitored a structured T2T strategy. They were available for consultation, provided patient education, and followed laboratory values, including sUA, which they used to adjust treatments.
At 2 years, the proportion of patients maintained at the target sUA was almost twice as great in the nurse-led arm . This was also true of patients aged 70 years or older , patients with tophi , and patients with sUA > 0.5 mmol/L at baseline . Nurse-led care also kept a greater proportion of patients at target who entered the study with an estimated glomerular filtration rate < 60 mL/min/1.73 m or were taking diuretics .
Within a T2T strategy, nurses focused on reaching the target might do a better job than physicians in consistently monitoring and adjusting therapies as needed, but Larsen also speculated that nurses might offer a more collaborative approach and provide greater support through patient education and regular telephone contact.
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