Mobile Health App Improves Treatment Compliance, Health Knowledge in Gout

Credit: Adobe Stock/Romolo Tavani

Continuous care with the help of a mobile health (mHealth) app was shown to improve knowledge levels and treatment compliance among a cohort of patients with gout, according to a study published in JMIR mHealth and uHealth.¹

“Although the treat-to-target approach has been widely recognized, gout control remains suboptimal,” wrote a group of international investigators led by Ying Wang, MSN, associated with the Department of Rheumatology and Immunology, West China Hospital, West China School of Nursing, Sichuan University, in China. “Therefore, Chinese patients with gout urgently need to improve disease-related knowledge and treatment compliance.”

Continuous care uses specific approaches to ensure patients receive the same level of collaborative, comprehensive care throughout their treatment and management journey. Ideally, this type of care should be highly accessible, convenient, and economical. Currently, these strategies mainly consist of a combination of telephone follow-ups, face-to-face counseling, sending health-related content through social media, and delivering health information to patients via manuals. While these methods have their advantages, they have been shown to exhibit poor accessibility, small coverage, and low efficiency. Other models of continuous care, such as internet-based mHealth apps, may offer improved health services for this patient population.²

The single-center, single-blind, parallel-group, randomized controlled trial recruited patients with gout from the West China Hospital of Sichuan University in Chengdu, China, to assess the impact of mHealth-based continuous care on improving treatment compliance and gout knowledge as well as reducing serum uric acid (SUA) levels. Patients were randomly assigned to either the intervention cohort or control cohort.

Participants in the intervention group were given continuous care using an mHealth app for 24 weeks. The app included modules for health records, education materials, and interactive support. Controls received face-to-face health education, paper-based education materials, and patient-initiated telephone consultations.

Both groups participated in a follow-up appointment at 6 months. The individual’s knowledge of gout and treatment compliance were measured at baseline, 12 weeks, and 24 weeks, while SUA levels were measured at baseline and 24 weeks. Efficacy was determined using a generalized estimating equation model and the intention-to-treat principle.

Ultimately, 120 patients were randomized into the intervention (n = 60) and control (n = 60) groups. Most (77.5%, n = 93) patients completed the entire study. Baseline measurements, clinical characteristics, and sociodemographic variables were comparable between groups (P >.05).

However, patients placed in the intervention group reported significant improvements in gout knowledge levels over time compared with controls (β = .617, 95% confidence interval [CI] .104 — 1.129; P = .02 and β = 1.300, 95% CI .669 — 1.931; P <.001 at 12 and 24 weeks, respectively).

Although there was no significant difference in treatment adherence at the 12-week mark among groups (β = 1.667, 95% CI −3.283 — 6.617; P = .51), a statistical difference was noted at week 24 (β = 6.287, 95% CI 1.357 — 11.216; P = .01). No significant differences in SUA changes were observed between groups, although levels were below baseline at week 24 in both cohorts (P = .43).

Investigators noted limitations including only recruiting patients from a single hospital in Sichuan, China, with a disproportionate number of male patients, which could limit the generalizability of the findings. Eligible patients also needed to be able to use smartphones and have certain learning abilities, which could further hinder generalizability among all patients with gout. Additionally, sustainability could not be established as the study was 24 weeks long. Investigators encourage future multicenter studies—which would include patients with other rheumatic diseases as well—with a longer follow-up duration to confirm these results.

“We suggest incorporating this intervention modality into standard continuous care for patients with gout,” investigators concluded.

References

1. ^{Wang Y, Chen Y, Song Y, et al. The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2024;12:e47012. Published 2024 Apr 11. doi:10.2196/47012}
2. ^{Miao HL, Zhang LY, Zhang XH, Yan M, Gao X. Application of WeChat education model in continuity of care of discharged patients with gout [Article in Chinese]. Chinese Nur Res. Aug 2017;31(23):2901-2903.}