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Gout Self-Management in African-American Veterans: A Qualitative Exploration of Challenges and Solutions from Patients' Perspectives.

Research paper by Jasvinder A JA Singh, Ivan I Herbey, Aseem A Bharat, Janet E JE Dinnella, Sally S Pullman-Mooar, Seth S Eisen, Nataliya N Ivankova

Indexed on: 25 Jan '17Published on: 25 Jan '17Published in: Arthritis Care & Research



Abstract

To explore gout self-management and associated challenges and solutions in African-Americans.We conducted semi-structured interviews with 35 African-Americans veterans with gout, who received healthcare at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months and had ULT a medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self-management, including: initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support.35 African-American veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n=18) or Philadelphia (n=17) VA medical centers. Mean age was 65 years, mean BMI 31.9 kg/m(2) , 97% had hypertension, 23% coronary artery disease and 31% renal failure. The main themes motivating African-American veterans to better gout self-management were: fear of pain; adherence to medications, self-discipline, lifestyle changes, information gathering and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and Internet sources.Identified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African-American men with gout. This article is protected by copyright. All rights reserved.