Mary De Vera

Introduction: Suboptimal medication adherence and poor health outcomes in patients with gout, the most common inflammatory arthritis, has prompted efforts to optimize care delivery. The Virtual Gout Clinic, an electronic health technology supported collaborative care model for gout involving rheumatology, pharmacy, and dietetics, offers a promising solution. The purpose of this thesis is to gain an in-depth understanding of how individuals engage in managing their gout and also explore the complexity of the Virtual Gout Clinic using mixed methods to optimize the context and delivery of this care model.Objectives: 1) To explore individual experiences with gout in a Canadian population and to understand the phenomenon of becoming actively engaged in the management of gout with an emphasis on factors which facilitate management; and 2) to explore how participants with gout experience the Virtual Gout Clinic and to understand and explain quantitative outcomes from the evaluation of this care model.Methods: For the first objective, I used a constructivist grounded theory design and conducted semi-structured telephone interviews with participants diagnosed with gout completing the Virtual Gout Clinic. I applied an explanatory sequential mixed methods design for objective 2, as this design enables interview questions used in the qualitative component to be informed by quantitative outcomes of the Virtual Gout Clinic (adherence, serum uric acid) for a comprehensive final interpretation. Results: 1) Analysis of 12 interviews constructed four themes: describing the severity of gout; processing the diagnosis and management of gout; interfering with management of gout; and facilitating management of gout. 2) The experience of the Virtual Gout Clinic was described by three conceptual categories: learning through the Virtual Gout Clinic; receiving personalized support; and knowing someone cares. Suboptimal health outcomes were explained by practical and perceptual barriers to gout management, such as lacking knowledge and fearing side-effects of medications. Conclusion: This thesis provided novel insight into the process of patients becoming actively engaged in the management of gout with an emphasis on facilitating factors. An interdisciplinary model of care is a promising approach to optimize care delivery by providing both emotional and practical support as well as ongoing individualized education.

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