Key role of the Clinical Nurse Specialist in patients with gout: results of a quality-of-care survey


E. Calvo-Aranda 1, FM. Sanchez-Aranda, L. Cebrian-Mendez, MA. Matias De La Mano, L. Lojo-Oliveira, MT. Navio-Marco

Servicio de Reumatología. Hospital Universitario Infanta Leonor


Background: Gout is the most common nontraumatic arthritis. With a prevalence in Spain of 2.4% and an increasing incidence, many gout patients are treated in Rheumatology. Different comorbidities complicate the management of this disease that not only attacks joints, but also induces kidney damage and accelerated atherosclerosis. This, together with a poor adherence to urate-lowering therapies and a suboptimal management, justifies its relevant morbidity and mortality, with high socioeconomic impact. Some studies suggest enhancing the role of the Clinical Nurse Specialist (CNS) in the care of gout to combat therapeutic failure.

Objectives: To determine the factors that affect the perceived quality and satisfaction of gout patients treated in Rheumatology with CNS support and identify areas for improvement.

Methods: In 2018, we implemented the following nurse-supported visit protocol: - 1st (rheumatologist and nurse; face-to-face): clinical history, joint examination, vital signs, anthropometrics, start of treatment, comorbidities management, health promotion. - 2nd (nurse; telephone, after analytical results): 1 month after 1st visit. Targeted questions (adherence, side effects, attacks, blood pressure, lifestyle habits) and therapeutic adjustment. - 3rd (rheumatologist and nurse; face-to-face): at 3-6 months. Targeted questions, joint examination, vital signs, anthropometrics, therapeutic adjustment, health promotion. - 4th (rheumatologist and nurse; face-to-face): at 12 months. Targeted questions, examination, therapeutic adjustment, health promotion. Subsequently, semiannual/annual appointments in Rheumatology or Primary Care, according to patient complexity and gout control. We applied a treat-to-target strategy (serum uric acid <5-6 mg/dl), facilitating patient access to us in case of attack, side effects or doubts. We conducted a cross-sectional observational study with demographic data and questions about care aspects included in a survey. We invite to respond anonymously and voluntarily to patients with a follow-up of ≥6 months.

Results: 44 surveys were obtained between August 2019 and January 2020. 95% male, 55% with an age range of 46-60 years; 41% >60 years. 68% considered the referral time to our Department reasonable; excessively long for 14%. All respondents were satisfied with the face-to-face nurse-supported consultation, and 93% considered the telephone CNS consultation to be good. 57% were not able to remember the name of the CNS, compared to 27% who did not know the rheumatologist name. 91% considered that the time to solve doubts and for explanations was enough. 46% considered the availability of CNS/rheumatologist as good, and 37% as excellent. The global satisfaction was good in 48% and excellent in 43%.

Conclusion: We found a high global satisfaction in gout patients followed in our Department. They valued very positively the role of CNS in the face-to-face and telephone consultations, as well as the staff availability, their dedication to answer questions and offer explanations. We must remember our names to patients and optimize referral to our Department. Exploring patients’ opinions is essential. It improves communication, adherence and attention offered, and allows to provide them a better experience in their relationship with the Department.

References: 1. Doherty M, Jenkins W, Richardson H, et al. 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. Lancet. 2018;392(10156):1403–1412. doi:10.1016/S0140-6736(18)32158-5 2. Fuller A, Jenkins W, Doherty M, Abhishek A. Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study [published online ahead of print, 2019 Aug 13]. Rheumatology (Oxford). 2019;kez333. doi:10.1093/rheumatology/kez333