Objective To assess health- and patient-centered outcomes in gout across Europe, and explore patient-, care-, and country-level characteristics associated with these outcomes. Methods Patients with self-reported physician-diagnosed gout from 14 European countries completed an online survey. Multivariable mixed-effect logistic and linear regressions were computed for health outcomes (gout flare recurrence) and patient-centered outcomes (patient satisfaction with current medication, and unaddressed goals), accounting for clustering within countries. The role of patient-, care- and country-level factors was explored. Results 1029 patients, 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% were 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 of being satisfied was still between 57% and 75% among patients with ≥3 flares but who were not receiving ULT. Finally, patients from wealthier and Northern European countries more frequently had ≥3 gout flares. Conclusion 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 physicians' gout management decisions is warranted to improve quality of care and gout outcomes across Europe.
Linking the Unitary Paradigm to Policy through a Synthesis of Caring Science and Integrative Nursing
