Abstract
The treat-to-target approach for serum uric acid is the recommended model in gout management according to the 2012 American College of Rheumatology (ACR) guidelines. Adherence to urate-lowering therapy (ULT) can be difficult for patients due to barriers, which include medication burden, financial hardship, and lack of medical literacy. Our aim was to create a pharmacist-managed referral for the titration of ULT to target serum uric acid (sUA) levels in a complex patient population. We utilized a clinical database to query patients seen at a rheumatology clinic over a 12-month period with an ICD-10 diagnosis for gout. The referral criteria were indications for ULT per the 2012 ACR guidelines. Rheumatology providers, consisting of attendings, fellows, and a physician assistant, were asked to refer the identified patients to the pharmacist-managed titration program. The intervention group consisted of 19 referred patients and the control group consisted of 28 non-referred patients. The baseline sUA (median (IQR)) at the time of referral was 8.8 (2) mg/dL for the intervention group and 7.6 (2.8) mg/dL for the control group (p = 0.2). At the end of the study period, the sUA was 6.1 (1.4) mg/dL for the intervention group and 6.8 (3.2) mg/dL for the control group (p = 0.08). At the end of the study period, 6 of 19 (32%) intervention group and 7 of 28 (25%) control group were at goal (p = 0.3). A newly instituted pharmacist-managed titration program was able to achieve lower average sUA levels in referred patients compared to demographically similar individuals who received standard gout management.
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Jean W. Liew is supported by a National Institutes of Health training Grant (T32AR007108).
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Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: IJH, JWL, MBM, SZ, CC, AMB. Drafting the work or revising it critically for important intellectual content: IJH, JWL, MBM, SZ, CC, AMB. Final approval of the version to be published: IJH, JWL, MBM, SZ, CC, AMB. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: IJH, JWL, MBM, SZ, CC, AMB.
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Huang, I.J., Liew, J.W., Morcos, M.B. et al. Pharmacist-managed titration of urate-lowering therapy to streamline gout management. Rheumatol Int 39, 1637–1641 (2019). https://doi.org/10.1007/s00296-019-04333-5
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DOI: https://doi.org/10.1007/s00296-019-04333-5