This GP Research Activity aims to improve the effectiveness of management of patients with gout, who often are not adherent to their serum urate-lowering therapy (ULT), and whose gout is not controlled.
The trial component of the activity will compare the effectiveness of two mobile apps, designed to assist people with gout in self-managing their gout. Participating GPs are requested to identify, screen, and recruit at least 3 patients, who have had at least 2 attacks of gout in the past year, are receiving or eligible to receive ULT to prevent attacks and have access to a smartphone or tablet with access to the internet. GPs will review the patients at least 3 times within 1 year after gaining consent from the patients (0, 6 and 12 months), and monitor their serum uric acid and creatinine levels as required.
The activity also involves eLearning modules on cluster randomised controlled trials at the start and the management of gout at the completion of trial participation.
Relevance to General Practice
Gout prevalence is increasing despite effective therapies to lower serum urate concentrations to 0.36 mmol/L or less, which, if sustained, significantly reduces acute attacks of gout. Adherence to urate lowering therapy (ULT) is poor, with rates of less than 50% one year after initiation of ULT. Innovative self-management tools are needed to address this issue. These mobile apps are designed to be integrated into primary care, and if found to be effective, have the potential to become a patient-centred self-management tool to be used in routine chronic care for gout patients.
Results of the trial will be critical in providing robust evidence to inform the appropriate use of electronic self-management tools in patients with gout. The study will inform aspects of the use of apps in general practice, that may be useful in other health conditions.
- Identify patients with inadequately controlled gout for potential admission to the study.
- Determine whether the use of an electronic self-management tool in patients with gout is effective in achieving a target serum urate level in those patients.
- Identify a situation in which the use of an electronic self-management tool may be beneficial for patients with gout.
- Explain why a cluster randomised controlled trial is a useful trial design in primary care, and discuss best practice in recruiting patients to clinical trials.
- Develop a review schedule for long-term management of gout, adjust the dose of urate lowering therapy, and know how to reduce the risk of adverse effects.
Domains of General Practice
D1. Communication skills and the patient-doctor relationship
D2. Applied professional knowledge and skills
D3. Population health and the context of general practice
D4. Professional and ethical role
D5. Organisational and legal dimensions
Curriculum Contextual Units
- Adult health
- Musculoskeletal and sports medicine
- General practice research
Macquarie University, The University of Wollongong, Western Sydney University, The George Institute for Global Health, The University of Sydney, and The University of South Australia, NPS MedicineWise, Pharmaceutical Society of Australia