Table 4.

Intervening stage literature review results.

Publication	Objective	Methods	Findings	Information Type	Conclusion
Lindsay, et al. [22]	Explore the experience and attitudes of men with gout, especially those affecting outcomes w/emphasis on barriers to urate-lowering therapy.	Qualitative grounded theory interviews of 11 men with gout. Categorized by themes using NVivo.	Patients learn treatment methods from other family members with gout. Lack of knowledge about long term treatment. Perception of gout as something that must be endured.	treatment	Patients only aware of anti-inflammatories and diet and exercise as symptom management options.
Abhishek, et al. [27]	Explore the effects of nurse-led intervention on ULT adherence.	Proof of concept study: 5 year follow up questionnaire to patients that had participated in a previous intervention.	Very high proportion of responders had excellent ULT adherence and EULAR target SUA level.	treatment	Personalized interactive education can have long term effects on ULT persistence.
Mikuls, et al. [35]	Examine the impact of pharmacist-driven intervention to optimize allopurinol therapy.	Randomized evaluation of pharmacist led intervention via telephone	Intervention patients showed increased adherence and met SUA goals.	treatment	Shows that simple interventions can be effective, but most patients still failed to reach the low SUA levels generally recommended.
Serawate, et al. [28]	Determine treatment patterns, specifically for allopurinol.	Retrospective claims analysis using multivariable logistic regression for factors associated with adherence to allopurinol therapy.	Previous diagnosis was positively associated with treatment compliance, while post index SUA flares indicated less compliance	treatment	Newly diagnosed and flare patients may require more education to promote therapy compliance.
Galo, et al. [29]	Identify and assess medication adherence intervention studies for rheumatic diseases.	Systematic literature review: "searched Medline (1946–June 2014), Embase (1974–June 2014) and International Pharmaceutical Abstracts (1970–June 2014). We used Medical Subject Headings for concepts underlying our search, ‘medication adherence’, ‘intervention’ and ‘inflammatory arthritis’ and applied keywords for concepts that did not map."	All interventions that had an effect on adherence included an education component and were tailored to the patient.	treatment	Patients need personalized education about therapies including proper administration and risks/benefits and
Dalbeth, et al [31]	Examine the relationship between illness perceptions of gout patients and disease outcomes, particularly medication adherence and musculoskeletal disability.	Questionnaire for patients with gout for under 10 years.	Patients with greater understanding of gout also reported a higher need for, less concern about, and stronger adherence to ULT.	treatment	Interventions to improve disease understanding may reduce concerns about ULT and increase adherence.
Robinson & Schumacher [36]	Examine characteristics, including readability, content, and construction, of gout patient education materials from different countries and organizations.	Analysis of written patient information content.	"treating serum uric acid (SUA) to target and prophylaxis against acute flare during urate-lowering therapy (ULT) initiation and titration" were absent in 60% of the studied resources.	treatment	Information content coverage is generally good, but the most commonly missing information is important." Failure to understand that SUA needs to be below a certain threshold (the target) may prevent patients from returning to their doctor for assessment of their SUA and titration of their ULT. Being unaware of the importance of using anti-inflammatory prophylaxis against acute flares could reduce adherence during ULT initiation and titration. This lack of such prophylaxis would allow more flares and cause patients to stop ULT and/or lose confidence in their doctors.:
Rees, et al. [25]	Test effectiveness of nurse-led intervention based on 'best practices' delivered in a hospital-based gout clinic setting.	Proof of concept study: education intervention followed by measurement of SUA at 12 months.	Package of care’ that includes patient education, individualized lifestyle advice and slow upward titration of ULT according to serial SUA levels achieved target levels in over 90% of patients.	pathophysiology including cause of gout, its risk factors and prognosis (including the risk of chronic joint damage), and available treatment strategies that can eliminate the crystals	Given proper education, knowledge of their therapeutic target, and regular contact with a nurse specialist,
Aung, et al. [33]	Review and discuss intervention strategies to improve ULT adherence and gout outcomes.	Review of treatment interventions	Patients are concerned about lack of information and understanding about treatment strategy.	Pathogenesis, treatment	Patients feel that healthcare visit time is too short to provide adequate information and discussion about gout, leading them to rely on Internet sources.
Reach [30]	Discuss reasons for gout treatment strategies and review literature on adherence.	Literature review	Patients often stop taking medications because they believe they are not working or bring on attacks when attacks occur early in therapy.	treatment, disease progression	Patients need to be informed about the reasons for increased attacks upon treatment initiation and understand that long term adherence decreases the risk of attacks.
Singh [32]	Assess barriers to treatment.	NGT study of African Americans and women with gout diagnosis code about gout treatment.	Patient worries about medication interactions and side effects. Not sure which medications for every day vs. during attacks. All groups indicated concerns about dietary modifications.	treatment, lifestyle	Patients need provider advice about diet. Medication concerns are common for chronic conditions and not specific to gout.