Robert Goldfien1, Alice Pressman2, Alice Jacobson3, Michele Ng4, Andrew Avins5. 1. Chair of the Chiefs of Rheumatology for The Permanente Medical Group in Richmond, CA. robert.goldfien@kp.org. 2. Director of Analytics and Evaluation in the Department of Research, Development, and Dissemination for Sutter Health in Walnut Creek, CA. pressmar@sutterhealth.org. 3. Senior Statistical Analyst in the Department of Research, Development, and Dissemination for Sutter Health in Walnut Creek, CA. jacobsa1@sutterhealth.org. 4. Clinical Pharmacist in the Department of Outpatient Pharmacy at the Oakland Medical Center in CA. michele.s.ng@kp.org. 5. Research Scientist at the Division of Research in Oakland, CA. andy.l.avins@kp.org.
Abstract
CONTEXT: Relatively few patients with gout receive appropriate treatment. OBJECTIVE: To determine whether a pharmacist-staffed gout management program is more effective than usual care in achieving target serum uric acid (sUA) levels in gout patients. DESIGN: A parallel-group, randomized controlled trial of a pharmacist-staffed, telephone-based program for managing hyperuricemia vs usual care. Trial duration was 26 weeks. MAIN OUTCOME MEASURES: Primary outcome measure was achieving sUA levels at or below 6 mg/dL at the 26-week visit. Secondary outcome was mean change in sUA levels in the control and intervention groups. Participants were adults with recurrent gout and sUA levels above 6.0 mg/dL. Participants were randomly assigned to management by a clinical pharmacist following protocol or to monitoring of sUA levels but management of their gout by their usual treating physician. RESULTS: Of 102 patients who met eligibility criteria, 77 subjects obtained a baseline sUA measurement and were entered into the trial. Among 37 participants in the intervention group, 13 (35%) had sUA levels at or below 6.0 mg/dL at 26 weeks, compared with 5 (13%) of 40 participants in the control group (risk ratio = 2.8, 95% confidence interval [CI] = 1.1 to 7.1, p = 0.03). The mean change in sUA levels among controls was +0.1 mg/dL compared with -1.5 mg/dL in the intervention group (sUA difference = -1.6, 95% CI = -0.9 to -2.4, p < 0.001). CONCLUSIONS: 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.
RCT Entities:
CONTEXT: Relatively few patients with gout receive appropriate treatment. OBJECTIVE: To determine whether a pharmacist-staffed gout management program is more effective than usual care in achieving target serum uric acid (sUA) levels in goutpatients. DESIGN: A parallel-group, randomized controlled trial of a pharmacist-staffed, telephone-based program for managing hyperuricemia vs usual care. Trial duration was 26 weeks. MAIN OUTCOME MEASURES: Primary outcome measure was achieving sUA levels at or below 6 mg/dL at the 26-week visit. Secondary outcome was mean change in sUA levels in the control and intervention groups. Participants were adults with recurrent gout and sUA levels above 6.0 mg/dL. Participants were randomly assigned to management by a clinical pharmacist following protocol or to monitoring of sUA levels but management of their gout by their usual treating physician. RESULTS: Of 102 patients who met eligibility criteria, 77 subjects obtained a baseline sUA measurement and were entered into the trial. Among 37 participants in the intervention group, 13 (35%) had sUA levels at or below 6.0 mg/dL at 26 weeks, compared with 5 (13%) of 40 participants in the control group (risk ratio = 2.8, 95% confidence interval [CI] = 1.1 to 7.1, p = 0.03). The mean change in sUA levels among controls was +0.1 mg/dL compared with -1.5 mg/dL in the intervention group (sUA difference = -1.6, 95% CI = -0.9 to -2.4, p < 0.001). CONCLUSIONS: 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.
Authors: Dinesh Khanna; Puja P Khanna; John D Fitzgerald; Manjit K Singh; Sangmee Bae; Tuhina Neogi; Michael H Pillinger; Joan Merill; Susan Lee; Shraddha Prakash; Marian Kaldas; Maneesh Gogia; Fernando Perez-Ruiz; Will Taylor; Frédéric Lioté; Hyon Choi; Jasvinder A Singh; Nicola Dalbeth; Sanford Kaplan; Vandana Niyyar; Danielle Jones; Steven A Yarows; Blake Roessler; Gail Kerr; Charles King; Gerald Levy; Daniel E Furst; N Lawrence Edwards; Brian Mandell; H Ralph Schumacher; Mark Robbins; Neil Wenger; Robert Terkeltaub Journal: Arthritis Care Res (Hoboken) Date: 2012-10 Impact factor: 4.794
Authors: Reva C Lawrence; David T Felson; Charles G Helmick; Lesley M Arnold; Hyon Choi; Richard A Deyo; Sherine Gabriel; Rosemarie Hirsch; Marc C Hochberg; Gene G Hunder; Joanne M Jordan; Jeffrey N Katz; Hilal Maradit Kremers; Frederick Wolfe Journal: Arthritis Rheum Date: 2008-01
Authors: Robert D Goldfien; Michele S Ng; Goldie Yip; Alice Hwe; Alice Jacobson; Alice Pressman; Andrew L Avins Journal: BMJ Open Date: 2014-01-10 Impact factor: 2.692
Authors: Ted R Mikuls; T Craig Cheetham; Gerald D Levy; Nazia Rashid; Artak Kerimian; Kimberly J Low; Brian W Coburn; David T Redden; Kenneth G Saag; P Jeffrey Foster; Lang Chen; Jeffrey R Curtis Journal: Am J Med Date: 2018-11-29 Impact factor: 4.965
Authors: Irvin J Huang; Jean W Liew; Meredith B Morcos; Silu Zuo; Carol Crawford; Alison M Bays Journal: Rheumatol Int Date: 2019-05-30 Impact factor: 2.631