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Owning My Gout- A Pharmacist-led collaborative gout management model at Counties Manukau DHB

Phone, D 2017 Owning My Gout- A Pharmacist-led collaborative gout
management model at Counties Manukau DHB.
International Journal of
Integrated Care
, 18(S1): A38, pp. 1-8, DOI:
Owning My Gout- A Pharmacist-led collaborative gout management model at
Counties Manukau DHB
1st Asia Pacific Conference on Integrated Care, Brisbane, 06-08 Nov 2017
Diana Phone
Ko Awatea, Counties Manukau DHB, New Zealand
Introduction: Gout is a chronic condition caused by excess monosodium urate crystal
deposition in and around joints, ligaments and tendons. It causes painful inflammation and
swelling, limits function and has a negative impact on quality of life.
Gout affects over 15,000 people over the age of 15 in the Counties Manukau region
Men, Maori and Pacific people most affected
Average of 360 hospital admissions/ year at Middlemore Hospital due to gout
Estimated cost of admissions being around $1,152,000 per year
Short description of practice change implemented: Gout management involves treatment of
an acute attack, lifestyle modification and urate lowering treatment to achieve a target level.
Community Pharmacists are ideally placed to work in collaboration with GP’s and patients to
improve the management of diagnosed gout, through the ordering of urate levels, ensuring
dose titration of allopurinol and providing self- management advice to patients.
Aim and theory of change: The aim of OMG is to develop a collaborative model of care where
the patients, their GP, nurses and pharmacists will work together to:
Titrate allopurinol to achieve serum urate levels below target (0.36mmol/L)
Improve adherence to treatment and lifestyle modifications.
Targeted population and stakeholders:
Targeted population: Patients with gout
Stakeholders: Community pharmacists, GP, nurses, Ko Awatea and Counties Manukau District
Health Board
Timeline: This project started mid-2014, and has really gained momentum over the last 12
Highlights (innovation, impact and outcomes): Results so far have been promising, with three
GP’s and three pharmacies providing this service to seventy patients across the region. In
August, 3 new pharmacies and general practices will start piloting this model of care.
Phone; Owning My Gout- A Pharmacist-led collaborative gout management model at
Counties Manukau DHB
Achievements to date:
Pharmacists working at top of scope of practice
Three general practices and three pharmacies providing service to seventy patients
Statistically significant reduction in serum urate levels of enrolled patients
Translation of Stop Gout Booklet into Mandarin, Samoan and Tongan
Counties Manukau DHB has approved funding for 6 pilot pharmacies (at
$27.70/patient/month) to provide the service for one year starting July 2017.
Positive feedback from patients, nurses and GPs.
A model that supports collaboration between patients, GPs, nurses and pharmacists.
Comments on sustainability: Once training has been provided, and the model implemented it is
able to be sustained by the pharmacy/GP. For this work to spread further, a more sustainable
way of training will be needed (eg e-learning).
Comments on transferability: This community pharmacist-led service model is adaptable and
has the potential to be spread within Counties Manukau and nationally and also applied to
other chronic conditions
Conclusions: This gout management model has shown benefits to both patients and health care
providers and has great potential for spread
Keywords: gout; pharmacists; gps; nurses; collaboration
... Th e Gout Stop programme is based on the publication entitled ' Treating acute gout and starting prevention in 7 minutes '. 6 Goldfi en et al . 7 in the US and Phone 8 in New Zealand have published other pharmacist-led collaborative programmes, but neither included a community support worker role. Northland's high Māori and Pacifi c populations, 9 the inequity of gout-related health outcomes in Māori and Pacifi c people 3 and the need to individualise treatment to achieve successful gout prevention and management are further driving factors promoting the development of the Gout Stop Programme. ...
Full-text available
INTRODUCTIONThe Gout Stop Programme was developed for primary care in Northland, New Zealand, to address inequitable health outcomes for Māori and Pacific people with gout. AIMThe aim of the programme was to make it easier for clinicians to prescribe urate-lowering treatment, facilitate patient adherence through education and support, and reduce barriers to gout prevention and long-term management. METHODS From 2015 to 2017, patients with acute gout who met inclusion criteria were prescribed treatment according to a ‘Gout Stop Pack’ option, based on renal function and diabetes status. Patients were monitored by community pharmacists. Gout educators and a Gout Kaiāwhina (community support worker) provided education and support to patients and whānau (families). Patient completion of the programme and outcomes, according to target serum urate level, were recorded. Patient experience was documented using a questionnaire and rating scale. RESULTSIn total, 160 clinicians prescribed therapy at 887 patient presentations; 71% were Māori and Pacific patients. The completion rate was 55% in this group and 84% for the non-Māori and non-Pacific group. In the Māori and Pacific group, 40% reached the target serum urate level (≤0.36 mmol L-1) in 91 days, and 26% required further titration. In the non-Māori/non-Pacific group, these rates were 51% and 19% respectively. Following programme completion, 68% of Māori and Pacific patients and 65% of non-Māori and non-Pacific patients continued to take allopurinol. The 21 patients interviewed rated the programme as excellent or very good. DISCUSSIONCulturally appropriate education and support for patients and the primary care team was essential. Collaboration between prescribers, community pharmacists and support workers reduced barriers to initiating prevention and long-term urate-lowering treatment and urate testing in this high-needs gout population.
Aim: Despite the effectiveness and availability of urate-lowering therapies (ULT), we continue to see a number of advanced cases of tophaceous gout in the Pacific Islander and Māori population in Western Sydney. Although the high prevalence and increased severity of gout in this cohort has been well documented, there has been little qualitative research undertaken in Australia into the lived experience of this group of people. It is this gap in the research that our study aimed to address. Methods: Participants were recruited from the rheumatology clinics at Westmead and Blacktown Hospitals. Those eligible to participate were Pacific Islander and Māori patients with tophaceous gout currently living in the Western Sydney Local Health District (WSLHD). Data collection took the form of 10 semi-structured interviews, which were subsequently transcribed verbatim. A thematic analysis of the data was then performed. Results: Thematic analysis identified 6 key themes: lack of understanding of the disease and its potential effects; missed opportunities for intervention and disjointed care; chronic reliance upon corticosteroids; trivialization of gout as a nuisance illness; the substantial financial impact of chronic illness; and the all-consuming nature of severe gout. Conclusion: The human cost of severe tophaceous gout in this cohort is immense. All 10 participants exemplified the disease's devastating social effects. We propose 4 key recommendations: improved education regarding diagnosis and management; immediate prescription of ULT at first presentation; a lower threshold for out-of-hospital rheumatologist referral; and improved follow-up through a nurse- and pharmacist-led collaborative gout management program.
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