Ritch Te Kampe(1,2), Tim L. Jansen(2), Caroline Van Durme(1), Matthijs Janssen(2), Gudula Petersen(3), Annelies Boonen(1)
(1)Maastricht University Medical Center, Maastricht, The Netherlands (2)Viecuri Medical Center, Venlo, The Netherlands (3)Grünenthal Gmbh, Aachen, Germany
Background: To improve quality of care (QoC) for gout patients across Europe, it is essential to understand health- and patient-centred outcomes in a real-world setting.
Objective: The objective of this study was (1) to evaluate the impact of gout on gout specific and generic health as well on patient-centred outcomes in a real-world setting across 14 European countries, and (2) to explore which patient-, care-, or country characteristics contribute to variations in outcomes.
Methods: Patients with self-reported physician-diagnosed gout from 14 European countries completed an online survey. Multivariable mixed-effect logistic and linear regressions, accounting for clustering of patients within countries (random intercept), were computed for health outcomes (gout flare recurrence) and patient-centred outcomes (patient satisfaction with current medication and unaddressed treatment goals). The role of patient-, care- and country-level factors was explored. Of note, number of gout flares (≥ 3) was included as covariate for patient-centred outcomes.
Results: 1029 patients from 14 European countries and predominantly diagnosed by a general practitioner, participated. One or more gout flares were reported by 70% of patients and ≥ 3 flares by 32%. Gout patients reported 1.1±1.2 unaddressed goals, and 80% was satisfied with current medication. Patients with ≥ 3 and ≥ 1 flares were less likely to be treated with urate-lowering therapy (ULT) [OR:0.52(0.39-0.70) and OR:0.38(0.28-0.53), respectively], but more likely to have regular physician visits [OR:2.40(1.79-3.22) and OR:1.77(1.30-2.41)]. Three or more gout flares were also associated with lower satisfaction [OR:0.39(0.28-0.56)], and more unaddressed goals [B:0.36(0.19-0.53)]. Notwithstanding, the predicted probability to be satisfied with gout was between 57% and 75% among patients with ≥ 3 flares but receiving no ULT depending on the remaining explanatory factors of satisfaction. Remarkably, patients from wealthier and Northern-European countries had more frequently ≥ 3 gout flares.
Conclusions: Across Europe, many gout patients remain untreated despite frequent reported flares. Remarkably, a substantial proportion of them were still satisfied with gout management. A better understanding of patients’ satisfaction and its role in gout management decisions of physicians’ is warranted to improve QoC and gout outcomes across Europe.