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Randomized Controlled Trial
. 2016 Summer;20(3):15-234.
doi: 10.7812/TPP/15-234. Epub 2016 Jul 1.

A Pharmacist-Staffed, Virtual Gout Management Clinic for Achieving Target Serum Uric Acid Levels: A Randomized Clinical Trial

Robert Goldfien  1 , Alice Pressman  2 , Alice Jacobson  3 , Michele Ng  4 , Andrew Avins  5
Affiliations
Randomized Controlled Trial

A Pharmacist-Staffed, Virtual Gout Management Clinic for Achieving Target Serum Uric Acid Levels: A Randomized Clinical Trial

Robert Goldfien et al. Perm J. 2016 Summer.

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.

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Figures

Figure 1.
Figure 1.
Flow diagram of design of Gout Uric Acid ReDuction study. sUA = serum uric acid level (mg/dL).
Figure 2.
Figure 2.
Comparison of mean serum uric acid during study period. Values shown are at each study time point, with error bars indicating 95% confidence intervals (intention-to-treat analysis).
Figure 3.
Figure 3.
Net change in serum uric acid among individual evaluable participants in the intervention and usual care groups.
See this image and copyright information in PMC

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