Nurse-supported self-monitoring of serum urate by gout patients using a treat-to-target approach: a feasibility study

Objective: To assess the feasibility of a nurse-supported, treat-to-target (T2T) self-monitoring approach for gout patients initiating urate-lowering therapy (ULT) using point-of-care testing (POCT) of serum urate (SU) levels. Methods: A 24-week prospective feasibility study was conducted at the Sint Maartenskliniek in the Netherlands among 32 patients starting ULT, or recently started ULT and not at target. Participants received a POCT device to self-measure SU levels at home and report results every 4 weeks via a digital platform. Nurses provided education and dosing advice based on SU levels and monitored patient follow-up. Feasibility was assessed using Bowen's framework. Patient data were obtained through questionnaires and chart review, and stakeholder perspectives were collected through semi-structured interviews. Results: Patients found the intervention highly acceptable. Adherence to SU measurements was 93%, with minimal burden and few problems reported. The majority of the patients reached their SU target (75%). Patients had a median of 2 gout flares (interquartile range [IQR] 0-3). Stakeholders valued the intervention for the potential to increase patient engagement and care efficiency, though they emphasized the need for evidence on cost-effectiveness, clear protocols and appropriate patient selection. Conclusion: Nurse-supported self-monitoring for gout was acceptable, feasible and practical in this selected group of gout patients. The short-term SU target attainment was encouraging, warranting larger comparative randomized studies with longer follow-up to establish (cost-) effectiveness, and long-term disease control.