Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial

Abstract

Purpose: To test a pharmacist-led intervention to improve gout treatment adherence and outcomes. Methods: We conducted a site-randomized trial (n=1,463 patients) comparing a one-year, pharmacist-led intervention to usual care in gout patients initiating allopurinol. The intervention was delivered primarily through automated telephone technology. Co-primary outcomes were the proportion of patients adherent (proportion of days covered ≥0.8) and achieving a serum urate <6.0 mg/dl at one year. Outcomes were reassessed at year two. Results: Intervention patients were more likely than usual care patients to be adherent (50% vs. 37%; OR 1.68; 95% CI 1.30, 2.17) and reach serum urate goal (30% vs. 15%; OR 2.37; 95% CI 1.83, 3.05). In the second year (one year after the intervention ended), differences were attenuated,

Efficacy and Outcomes of a Novel Telephone-based Gout Disease Management Program

“…Similarly to our study, inthe RamP-UP study, patients were contacted directly by pharmacists (7). The SUA goal of ≤6 mg/dl was achieved in 30% of patients in the intervention group, in comparison to only 15% in the usual care group.…”

“…Pharmacist-and nurse-led telemedicine programs aimed at improving gout-related outcomes havebeen shown to not only improve medication compliance but have also demonstrated effectiveness in increasing the proportion of patients achieving goal SUA level of£6 mg/dl (7,8). However, to date, healthcare utilization and patient satisfaction with telemedicine programs havenot been studied.…”

Predictors of Success in Gout Treatment

“…Doherty, et al 21 have shown outstanding effect on attainment and maintenance of target SU of close supervision of patients with gout receiving ULT by trained nurses, but resourcing this approach on a large scale is challenging. Pharmacists, who are often well-placed to monitor medication adherence, offer a potentially cost-effective approach to improving outcomes for patients 22,23 .…”

Commentaries on the updated American College of Rheumatology guidelines for the management of gout. Urate-lowering drugs (Part 1)

“…Наш опыт обучающих мероприятий для пациентов позволяет согласиться, что подробная информация о подагре, в том числе о принципах ее лечения и самоконтроля, которую сообщает ревматолог, улучшает приверженность терапии и возможность достижения ее целей [39]. Аналогичные выводы были сделаны в ряде работ [40][41][42], в которых обучение пациентов проводилось медицинскими сестрами или фармакологами. Тем не менее метод получения пациентом информации имеет второстепенное значение [39], что подчеркивает условность рекомендации.…”