Summary points
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Consumers, especially those with chronic diseases, are increasingly adopting electronic tools and applications to manage their health
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A validated gout
Despite the availability of very effective urate-lowering therapies (ULT), the prevalence of gout is increasing (3% of adults in the United States in 2007) and its incidence is also rising rapidly [1], [2]. Authoritative guidelines for the effective management of chronic gout are available [3], [4], [5], [6]. The core advice of these guidelines is to lower and maintain serum uric acid (sUA) to ≤6 mg/dL (0.36 mmol/L; British Guidelines recommend ≤5 mg/dL (0.30 mmol/L)) [3], and to increase the dose of allopurinol, the predominantly used ULT, slowly until this is achieved. Remarkably, if these guidelines are followed, and ULT is commenced carefully, acute gout attacks will ultimately cease and the damaging effects of monosodium-urate deposits in joints and tissues will be avoided or minimised [7].
A study has shown that negative experiences and mistaken beliefs of patients with gout were major barriers to patients seeking information and advice about gout, and also impacted on their adherence to therapy [8]. Patients were unaware that the condition could be treated effectively, and general practitioners (GPs) were reluctant to commence ULT due to unfamiliarity with gout management guidelines and concerns regarding the risk for serious hypersensitivity to ULT drugs [9], [10]. Innovative methods are required to facilitate better gout management and overcome these barriers. A study in the United Kingdom, involving 106 gout patients, showed that a nurse-delivered combination of intensive, personalised education and lifestyle advice with appropriate ULT dosing advice was successful in achieving target sUA concentrations in 9 out of 10 gout patients, thus providing evidence that self-management can be effective [11].
A systematic review of factors associated with successful chronic disease management showed evidence supporting the effectiveness of interventions to support self-management by patients [12]. These factors included educational sessions and motivational counselling with health professionals, and decision-support tools for GPs [12]. The number of adults in the United States using the internet, especially on portable devices, such as cell phones or tablets, has increased, with two-thirds of cell phone owners using the device to go online [13], and the trend continues to rise [13], [14], [15]. Over half of smartphone owners use their mobile devices to go online to find health information [16], [17], with those suffering from chronic conditions more likely to do so [18]. Further, one in five smartphone owners have some form of health application (app) installed on their smartphone [19]. Electronic tools have been shown to be effective in supporting self-management, changing health behaviours such as improving medication adherence, and increasing compliance to guidelines for chronic diseases such as asthma, diabetes and juvenile idiopathic arthritis [20], [21], [22], [23]. Additionally, a meta-analysis demonstrated the effectiveness of providing individualised feedback to patients about their progress during interventions to support behaviour change [24]. Collectively, this evidence suggests that there is a sound argument for the development of electronic health tools such as mobile health (mHealth) apps, to enhance self-management of gout and other chronic health conditions, particularly if applications can be accessed on mobile devices such as smartphones.
Gout is a chronic disease in which patients have long-term challenges to maintain good control of their gout. Taking medication regularly, often for life, and having regular sUA tests are critical behaviours required. The change in behaviour of many gout patients needed to meet this standard is extremely challenging as evidenced by the low medication adherence rates and poor control of gout revealed in many studies [25], [26], [27]. Hence, the development of an mHealth app to support the required behaviour changes would be a significant advance in gout management. Gout is a strong candidate condition for self-management given the presence of an indicator, sUA, which correlates closely with the risk of gout attacks and can be monitored by patients. With an improved understanding of their condition, along with reminders and individual feedback, it is anticipated that gout sufferers will more likely reach and maintain target sUA concentrations through better treatment adherence. This review assessed mobile apps currently available to patients for the management of gout. To do so, a thorough examination of the apps was conducted which included comparison of the apps’ content and features against internationally accepted gout management guidelines, important for successful outcomes in individual patients.
A search was performed in the Apple App StoreSM for iPhone and iPad compatible mobile apps for gout management. The search in the Apple App Store using the term “gout” (in May 2015) retrieved 57 apps. The inclusion criteria for the apps to be included in the review were that the app had to be in English, primarily related to the disease gout, designed for patient use and incorporate elements of disease monitoring and/or patient education. The App Store description of each app was then read and
The six apps that met our inclusion criteria for review were ArthritisID, Gout by AZoMedical, Gout Channel, Gout Manager, iGoutapp and Managing Gout. The patient focused self-management features of these apps are summarised in Table 3.
Of the six mobile applications reviewed, two provided only educational material, namely ArthritisID and Gout by AZoMedical. ArthritisID provided users with information about the pathophysiology of gout, its diagnosis and treatment, whereas Gout by AZoMedical was a
For effective management of gout, patients need not only knowledge of their disease and its treatment, but also support and a clear rationale to adhere to treatment. The use of mobile applications to support self-management of chronic conditions presents much potential. The extent to which such apps contain content consistent with treatment guidelines and are user-friendly is central to their likely adoption and effectiveness. This review assessed features of gout management apps that were
None.
Conception and design of study: AN, MB, JW, RD.
Acquisition of data: AN, DK, RD.
Analysis and interpretation of data: AN, MB, DK, AT, AL, JW, RD.
Drafting article: AN, MB.
Revising article critically for important intellectual content: AN, MB, DK, AT, AL, JW, RD.
Final approval of version to be submitted: AN, MB, DK, AT, AL, JW, RD. Summary points Consumers, especially those with chronic diseases, are increasingly adopting electronic tools and applications to manage their health A validated gout
This project was supported by the National Health and Medical Research Council Program Grant 1054146.
Using these devices should facilitate dose titration to aid patients in reaching urate targets. Although many smartphone apps already exist to support patients with gout these are limited in the clinician guided support that they offer,9 although qualitative work suggests that patients appreciate a facility to track urate and flares over time.10 Self-management has been supported in many chronic health conditions, for example, incorporating home blood pressure monitoring results into routine clinical management has been shown to replicate the results of clinical trials on lowering blood pressure.11