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

Abstract

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 months. 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. 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