Ritch Te Kampe (1,2), Tim L. Jansen (2), Caroline Van Durme (1), Matthijs Janssen (2), Gudula Petersen (3), Annelies Boonen (1)
Affiliation(s):
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.