Abstract
Background: In Sweden, only one out of three persons with gout receive adequate preventive urate lowering treatment. Gout affects about two percent of the population and is characterized by painful attacks of arthritis. Without preventive treatment gout can become a chronic condition. A recent review shows that nurse-led care with a person-centred approach increases adherence to preventive treatment. Research on implementation states the importance of adapting the intervention to the environment where it will be integrated. Thus, the aim of this study was to describe the conditions for person-centred nurse-led gout care based on national treatment recommendation for gout in primary healthcare (PHC).
Methods: Focus group interviews were conducted at nine PHC units in three regions in the middle of Sweden. Individual interviews were held with managers from eight of the PHC units. The three main categories in the framework Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS); innovation, context and recipients, were used as a deductive matrix in the first step in the analysis. This was followed by an inductive analysis.
Results: Representing the main category innovation; nurse-led care was considered a favourable way of organizing care in general in PHC, enhancing quality of care and strengthening the work team, especially in times depending on temporary physicians. Lack of time could be a possible obstacle for expanding the areas of care led by nurses, as they already had taken over responsibilities from physicians. A contextual category, pointed out as being a problematic circumstance when organizing gout care, was waiting list restrictions that made it harder to follow the treatment recommendation for gout. Gout care was described as a holistic but fragmented responsibility, that competed with other responsibilities and reflected the broad divided agenda for PHC in general and a situation with limited resources. The importance of maintaining a person-centred perspective when organizing care and treatment was emphasized. This person-centred approach could be challenged if care was organised based on diagnosis e.g. nurse-led gout care. The use of supportive strategies and health professionals’ motivation was highlighted as important in the implementation of new practices . The motivation for following recommendations appeared be insufficient, due to varying knowledge on gout among staff, a low belief in preventive urate lowering treatment and a view on gout as a low-priority disease.
Conclusion: A robust strategy to support the implementation of person-centred nurse-led gout care based on national treatment recommendations needs to consider the conditions described in this study.
Keywords: gout, primary healthcare, staff perspectives, implementation, nurse-led care, person-centred care