Staff perspectives on existing practice and conditions for nurse-led gout care based on treatment recommendations: a qualitative study in primary health care

Background Gout affects nearly two percent of the population and is associated with repeated painful attacks of arthritis. Preventive urate-lowering therapy is widely available, but only one third of patients receive adequate treatment. Lack of knowledge among healthcare professionals and patients within primary healthcare are implicated as partial explanations for this undertreatment. Nurse-led care has proved to be an effective model when treating patients with gout, but there is a need for more knowledge about factors that can be expected to influence the future implementation of such care. The aim of this study was to describe the factors influencing existing gout care in primary healthcare and the conditions for a future implementation of nurse-led gout care based on national treatment recommendations. Methods In this qualitative study, focus group discussions with 56 nurses and physicians and individual interviews with eight managers were conducted at nine primary healthcare units in the middle of Sweden. A deductive qualitative content analysis based on the main constructs of the framework Integrated Promoting Action on Research Implementation in Health Services was followed by an inductive analysis within the frames of the main constructs: innovation, recipients and context. Results The construct “innovation” was described with the management of gout being patient initiated and in some respects complex, and with experiences of nurse-led care as a favourable model. The two categories of the construct “recipients” were represented by a view of gout as a low-priority condition with acute attacks and inadequate knowledge of gout, including preventive treatment. The construct “context” consisted of three categories: a view of primary healthcare as having a holistic but fragmented responsibility for gout care, recommendations against keeping waiting lists that complicate follow-up appointments, and the need for motivation and support when introducing new practices. Conclusion In this study, investigating the perspective of professionals, several factors were found to influence existing gout care. It will be crucial to target these factors in the development of a future implementation strategy.