Goldfien RD, Ng MS, Yip G, Hwe A, Jacobson A, Pressman A, Avins AL., BMJ Open. 4(1):e003627. doi: 10.1136/bmjopen-2013-003627., 2014 Jan 10
OBJECTIVES: The study objective was to determine the feasibility of using a pharmacist-staffed, protocol-based structured approach to improving the management of chronic, recurrent gout.
SETTING: The study was carried out in the outpatient clinic of a single Kaiser Permanente medical centre. This is a community-based clinic.
PARTICIPANTS: We report on 100 consecutive patients between the ages of 21 and 94 (75% men) with chronic or recurrent gout, referred by their primary physicians for the purpose of management of urate-lowering therapy. Patients with stage 5 chronic kidney disease or end-stage kidney disease were excluded.
INTERVENTIONS: The programme consisted of a trained clinical pharmacist and a rheumatologist. The pharmacist contacted each patient by phone, provided educational and dietary materials, and used a protocol that employs standard gout medications to achieve and maintain a serum uric acid (sUA) level of 6 mg/dL or less. Incident gout flares or adverse reactions to medications were managed in consultation with the rheumatologist.
PRIMARY OUTCOME MEASURE: The primary outcome measure was the achievement and maintenance of an sUA of 6 or less for a period of at least 3 months.RESULTS: In 95 evaluable patients enrolled in our pilot programme, an sUA of 6 mg/dL or less was achieved and maintained in 78 patients with 4 still in the programme to date. Five patients declined to participate after referral, and another 13 patients did not complete the programme. (The majority of these were due to non-adherence.)
CONCLUSIONS: A structured pharmacist-staffed programme can effectively and safely lower and maintain uric acid levels in a high percentage of patients with recurrent gout in a primary care setting. This care model is simple to implement, efficient and warrants further validation in a clinical trial.