Exploring current and potential roles of Australian community pharmacists in gout management: a qualitative study

Abstract

BackgroundGout is an increasingly prevalent form of inflammatory arthritis. Although effective treatments for gout exist, current management is suboptimal due to low medication adherence rates and treatments that are non-concordant with guidelines. Medications are the mainstay and most effective form of gout management. Thus, there is potential for community pharmacists to play an important primary health care role in gout management, however their current role and their potential to improve management of gout treatment is currently unclear. The purpose of the study is to explore the views of Australian pharmacists on their roles in gout management and to identify factors influencing their involvement in gout management.MethodsA convenience sample of community pharmacists were invited to participate using a snowballing recruitment strategy. Semi-structured, face-to-face interviews were conducted with 15 pharmacists of varying age, gender and pharmacy experience. Interviews focused on pharmacists’ experiences of managing gout, interactions with people living with gout and their perceived roles and responsibilities in gout management. Interviews were transcribed verbatim and independently analysed by two reviewers to identify themes.ResultsThe main role of pharmacists reported in gout management was providing patient education. The greatest facilitator to pharmacists involvement in gout management was identified to be pharmacists’ good understanding of gout and its management. Barriers to pharmacists involvement were identified to be difficulties in monitoring adherence to gout medications, low priority given to gout in the pharmacy compared to other chronic health conditions, and lack of specific training and/or continuing education in gout prevention and management.ConclusionsPharmacists can expand their primary health care role in gout management, particularly in the area of ongoing provision of education to people living with gout and in monitoring medication adherence in patients. However, a number of barriers need to be overcome including difficulties in monitoring patient adherence to medications, ensuring a higher priority is given to chronic gout management and providing continuing training to community pharmacists about gout. Implications for pharmacist practice include initiating conversations about medication adherence and education when dispensing medications and undertaking continuing education in gout.

What factors contribute to uncontrolled gout and hospital admission? A qualitative study of inpatients and their primary care practitioners

“…It is not viewed seriously as a form of inflammatory arthritis. Consequently, gout is considered a minor health condition and is being inappropriately treated as only an acute episodic condition rather than one requiring chronic ongoing treatment 34–36. These themes were also shown in our study when patients considered gout to be unremarkable compared with their other health conditions.…”

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

“…Although this prior study lacked a control group and relied on self-reports of adherence, these results suggest that a more intensive intervention -one that integrates patient education with regular in-person patient-provider interactions -could lead to greater and more durable improvements in adherence and outcomes. The potential importance of integrating patient education is further highlighted in reports demonstrating that gout-specific knowledge deficits (common among gout sufferers) might be amenable to relatively simple educational interventions delivered in part or wholly by non-physician providers such as pharmacists 34,35 . It is possible that a more resource-intensive strategy such as that described by Rees et al could be deployed in a stepwise, escalating fashion only after the failure of a less intensive (and more scalable) intervention (such as the one described in this study, delivered to 681 patients by a single half-time pharmacist).…”

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 .…”