title: Effectiveness of a pharmacist-based gout care management programme in a large integrated health plan: results from a pilot study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  The study was carried out in the outpatient clinic of a single Kaiser Permanente medical centre. This is a community-based clinic.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Rheumatology, Kaiser Permanente, Richmond, California, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Goldfien
authors.forename: Michele S
authors.initials: MS
authors.lastname: Ng
authors.forename: Goldie
authors.initials: G
authors.lastname: Yip
authors.forename: Alice
authors.initials: A
authors.lastname: Hwe
authors.forename: Alice
authors.initials: A
authors.lastname: Jacobson
authors.forename: Alice
authors.initials: A
authors.lastname: Pressman
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Avins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use; D000554:Ambulatory Care Facilities; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D006073:Gout / Q000097:blood / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010607:Pharmacy Service, Hospital; D010865:Pilot Projects; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol