Pharmacist-managed titration of urate-lowering therapy to streamline gout management
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 ha...
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| Veröffentlicht in: | Rheumatology international 2019-09, Vol.39 (9), p.1637-1641 |
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| creator | Huang, Irvin J. Liew, Jean W. Morcos, Meredith B. Zuo, Silu Crawford, Carol Bays, Alison M. |
| description | 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. |
| doi_str_mv | 10.1007/s00296-019-04333-5 |
| format | Article |
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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.</description><identifier>ISSN: 0172-8172</identifier><identifier>EISSN: 1437-160X</identifier><identifier>DOI: 10.1007/s00296-019-04333-5</identifier><identifier>PMID: 31147732</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Biomarkers - blood ; Databases, Factual ; Down-Regulation ; Female ; Gout - blood ; Gout - diagnosis ; Gout - drug therapy ; Gout Suppressants - administration & dosage ; Gout Suppressants - adverse effects ; Humans ; Hyperuricemia - blood ; Hyperuricemia - diagnosis ; Hyperuricemia - drug therapy ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Patient compliance ; Pharmacists ; Pharmacovigilance ; Professional Role ; Program Evaluation ; Referral and Consultation ; Rheumatism ; Rheumatology ; Time Factors ; Treatment Outcome ; Uric acid ; Uric Acid - blood ; Washington</subject><ispartof>Rheumatology international, 2019-09, Vol.39 (9), p.1637-1641</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>Rheumatology International is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-14cb22c3d12a86e6a1c114758e22b19d1bf6ee01b5d91549e21237bf234e8f0f3</citedby><cites>FETCH-LOGICAL-c375t-14cb22c3d12a86e6a1c114758e22b19d1bf6ee01b5d91549e21237bf234e8f0f3</cites><orcidid>0000-0002-8104-2450 ; 0000-0003-1324-5173 ; 0000-0002-1445-6848 ; 0000-0001-9462-2078 ; 0000-0002-7193-6303 ; 0000-0002-8094-3919</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00296-019-04333-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00296-019-04333-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31147732$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Irvin J.</creatorcontrib><creatorcontrib>Liew, Jean W.</creatorcontrib><creatorcontrib>Morcos, Meredith B.</creatorcontrib><creatorcontrib>Zuo, Silu</creatorcontrib><creatorcontrib>Crawford, Carol</creatorcontrib><creatorcontrib>Bays, Alison M.</creatorcontrib><title>Pharmacist-managed titration of urate-lowering therapy to streamline gout management</title><title>Rheumatology international</title><addtitle>Rheumatol Int</addtitle><addtitle>Rheumatol Int</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Databases, Factual</subject><subject>Down-Regulation</subject><subject>Female</subject><subject>Gout - blood</subject><subject>Gout - diagnosis</subject><subject>Gout - drug therapy</subject><subject>Gout Suppressants - administration & dosage</subject><subject>Gout Suppressants - adverse effects</subject><subject>Humans</subject><subject>Hyperuricemia - blood</subject><subject>Hyperuricemia - diagnosis</subject><subject>Hyperuricemia - drug therapy</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Patient compliance</subject><subject>Pharmacists</subject><subject>Pharmacovigilance</subject><subject>Professional Role</subject><subject>Program Evaluation</subject><subject>Referral and Consultation</subject><subject>Rheumatism</subject><subject>Rheumatology</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Uric acid</subject><subject>Uric Acid - blood</subject><subject>Washington</subject><issn>0172-8172</issn><issn>1437-160X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE1r3DAQhkVJabZp_0APwZBLL2pnJFuyjyEkbSCQHraQm5Dt8a6DbW0kmbD_Pto4TaCHXPQBz_vO8DD2DeEHAuifAUBUigNWHHIpJS8-sBXmUnNUcHfEVoBa8DIdx-xzCPeQ_krBJ3YsEXOtpVix9Z-t9aNt-hD5aCe7oTaLffQ29m7KXJfN6Ul8cI_k-2mTxS15u9tn0WUherLj0E-UbdwcsyU-0hS_sI-dHQJ9fblP2N-ry_XFb35z--v64vyGN1IXkWPe1EI0skVhS0XKYnPYqyhJiBqrFutOEQHWRVthkVckUEhdd0LmVHbQyRP2fendefcwU4hm7ENDw2AncnMwQkhZKtCACT37D713s5_SdgdKCK2gUokSC9V4F4Knzux8P1q_Nwjm4Nwszk1ybp6dmyKFTl-q53qk9jXyT3IC5AKE3cEh-bfZ79Q-AbtrjE4</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Huang, Irvin J.</creator><creator>Liew, Jean W.</creator><creator>Morcos, Meredith B.</creator><creator>Zuo, Silu</creator><creator>Crawford, Carol</creator><creator>Bays, Alison M.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8104-2450</orcidid><orcidid>https://orcid.org/0000-0003-1324-5173</orcidid><orcidid>https://orcid.org/0000-0002-1445-6848</orcidid><orcidid>https://orcid.org/0000-0001-9462-2078</orcidid><orcidid>https://orcid.org/0000-0002-7193-6303</orcidid><orcidid>https://orcid.org/0000-0002-8094-3919</orcidid></search><sort><creationdate>20190901</creationdate><title>Pharmacist-managed titration of urate-lowering therapy to streamline gout management</title><author>Huang, Irvin J. ; 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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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31147732</pmid><doi>10.1007/s00296-019-04333-5</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-8104-2450</orcidid><orcidid>https://orcid.org/0000-0003-1324-5173</orcidid><orcidid>https://orcid.org/0000-0002-1445-6848</orcidid><orcidid>https://orcid.org/0000-0001-9462-2078</orcidid><orcidid>https://orcid.org/0000-0002-7193-6303</orcidid><orcidid>https://orcid.org/0000-0002-8094-3919</orcidid></addata></record> |
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| subjects | Adult Aged Biomarkers - blood Databases, Factual Down-Regulation Female Gout - blood Gout - diagnosis Gout - drug therapy Gout Suppressants - administration & dosage Gout Suppressants - adverse effects Humans Hyperuricemia - blood Hyperuricemia - diagnosis Hyperuricemia - drug therapy Male Medicine Medicine & Public Health Middle Aged Patient compliance Pharmacists Pharmacovigilance Professional Role Program Evaluation Referral and Consultation Rheumatism Rheumatology Time Factors Treatment Outcome Uric acid Uric Acid - blood Washington |
| title | Pharmacist-managed titration of urate-lowering therapy to streamline gout management |
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