A Pharmacist-Staffed, Virtual Gout Management Clinic for Achieving Target Serum Uric Acid Levels: A Randomized Clinical Trial

Goldfien, Robert; Pressman, Alice; Jacobson, Alice; Ng, Michele S; Avins, Andrew L.

doi:10.7812/tpp/15-234

Cited by 52 publications

(47 citation statements)

References 21 publications

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“…In a later US randomised controlled trial involving 77 patients, pharmacist-led, telephone-based management of urate lowering therapy was compared with usual care led by primary physicians. 26 At 26 weeks, 13 (35%) of 37 patients in the pharmacist-led group compared with five (14%) of 40 in the physician-led group had serum urate less than 360 μmol/L.…”

Section: Discussionmentioning

confidence: 95%

Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial

et al. 2018

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SummaryBackgroundIn the UK, gout management is suboptimum, with only 40% of patients receiving urate-lowering therapy, usually without titration to achieve a target serum urate concentration. Nurses successfully manage many diseases in primary care. We compared nurse-led gout care to usual care led by general practitioners (GPs) for people in the community.MethodsResearch nurses were trained in best practice management of gout, including providing individualised information and engaging patients in shared decision making. Adults who had experienced a gout flare in the previous 12 months were randomly assigned 1:1 to receive nurse-led care or continue with GP-led usual care. We assessed patients at baseline and after 1 and 2 years. The primary outcome was the percentage of participants who achieved serum urate concentrations less than 360 μmol/L (6 mg/dL) at 2 years. Secondary outcomes were flare frequency in year 2, presence of tophi, quality of life, and cost per quality-adjusted life-year (QALY) gained. Risk ratios (RRs) and 95% CIs were calculated based on intention to treat with multiple imputation. This study is registered with www.ClinicalTrials.gov, number NCT01477346.Findings517 patients were enrolled, of whom 255 were assigned nurse-led care and 262 usual care. Nurse-led care was associated with high uptake of and adherence to urate-lowering therapy. More patients receiving nurse-led care had serum urate concentrations less than 360 μmol/L at 2 years than those receiving usual care (95% vs 30%, RR 3·18, 95% CI 2·42–4·18, p<0·0001). At 2 years all secondary outcomes favoured the nurse-led group. The cost per QALY gained for the nurse-led intervention was £5066 at 2 years.InterpretationNurse-led gout care is efficacious and cost-effective compared with usual care. Our findings illustrate the benefits of educating and engaging patients in gout management and reaffirm the importance of a treat-to-target urate-lowering treatment strategy to improve patient-centred outcomes.FundingArthritis Research UK.

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Section: Discussionmentioning

confidence: 95%

Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial

et al. 2018

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“…A pharmacist-coordinated program reported a greater number of intervention patients reaching their goal urate of < 6.0 mg/dL, but this reflected only 13 (35%) of the intervention patients vs. 5 (13%) of control group patients [ 63 ]. Another group looked at pharmacist-directed phone-based gout patient education and, in a recent abstract, reported that the intervention patients reached their serum urate goal more frequently than controls, but only 31.3% of 631 intervention patients vs. 20.6% of 782 control patients reached urate < 6.0 mg/dL [ 64 ].…”

Section: Individual and Group Patient Education Interventionsmentioning

confidence: 99%

How Can We Improve Disease Education in People with Gout?

Fields

Batterman

2018

Curr Rheumatol Rep

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Purpose of ReviewGout management is currently suboptimal despite excellent available therapy. Gout patient education has been shown to enhance medication adherence and self-management, but needs improvement. We explored the literature on gout patient education including gaps in gout patient knowledge; use of written materials; in-person individual and group sessions; education via nurses, pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile health app, and text messaging educational efforts.Recent FindingsNurse-led interventions have shown significant improvement in reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a lesser degree. A multi-disciplinary approach has shown feasibility. Needs-assessments, patient questionnaires, and psychosocial evaluations can enhance targeted education.SummaryAn interactive and patient-centered approach can enhance gout educational interventions. Optimal programs will assess for and address educational needs related to knowledge gaps, health literacy, race, gender, socio-economic status, and level of social support.

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“…Another randomised trial in California showed that the success rate of target sUA at 26 weeks was significantly higher in patients who received information by phone through a pharmacist versus usual care 16. Thus, care by a specialist and/or targeted programmes that include patient education or intensive frequent monitoring can improve our ability to achieve target sUA in gout.…”

mentioning

confidence: 99%

Chasing crystals out of the body: will treat to serum urate target for gout help us get there?

Singh

Uhlig

2016

Ann Rheum Dis

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A Pharmacist-Staffed, Virtual Gout Management Clinic for Achieving Target Serum Uric Acid Levels: A Randomized Clinical Trial

Abstract: A structured pharmacist-staffed program was more effective than usual care for achieving target sUA levels. These results suggest a structured program could greatly improve gout management.

Cited by 52 publications

References 21 publications

Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial

Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial

How Can We Improve Disease Education in People with Gout?

Chasing crystals out of the body: will treat to serum urate target for gout help us get there?

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