RESUMEN
BACKGROUND: The American College of Rheumatology strongly recommends a treat-to-target management strategy to achieve and maintain serum uric acid (sUA) less than 6 mg/dL to decrease risk of gouty flare recurrence and permanent joint damage. OBJECTIVE: To compare the effectiveness of rheumatology clinic pharmacists and primary care providers (PCPs) in achieving a target sUA goal in patients with gout. METHODS: This retrospective chart review included patients aged 18 years and older starting urate-lowering therapy (ULT) (allopurinol, febuxostat, or probenecid) for gout between January 1, 2015, and December 31, 2019. Exclusion criteria were ULT use within the previous 6 months, baseline sUA less than 6 mg/dL, and death within 12 months of starting ULT. From ULT initiation, data were collected until sUA less than 6 mg/dL was achieved or a maximum of 12 months. The primary outcome was the percentage of patients who achieved sUA less than 6 mg/dL. Key secondary outcomes were percent reduction in sUA and time to sUA target achievement. RESULTS: Of 62 patients included in each group, 75.8% of patients in the pharmacist cohort versus 30.6% of patients in the PCP cohort achieved target sUA less than 6 mg/dL (odds ratio 7.09, 95% confidence interval 3.28-16.11, P < 0.001). Patients in the pharmacist-managed group also achieved a greater reduction in mean sUA (-36.7% vs. -26.9% respectively, P = 0.001). Among patients achieving target sUA, median time to target was similar at 92 and 86 days, respectively, despite significantly lower initial mean allopurinol doses in the pharmacist-managed group (102 mg/d vs. 145 mg/d, P < 0.001). CONCLUSION: The odds of achieving target sUA within 12 months were 7 times higher if gout was managed by a rheumatology clinic pharmacist as compared with a PCP. This study suggests the need for prescriber education and supports expansion of pharmacist-led gout management to primary care settings.
RESUMEN
BACKGROUND: There is a need to improve blood glucose levels of underserved Latino patients with uncontrolled diabetes. OBJECTIVE: To determine the feasibility of a pharmacist and health promoter team designed to address the barriers to medication adherence and adjustment and improve self-care among Latinos with type 2 diabetes. METHODS: Clinical staff at the University of Illinois at Chicago Medical Center referred Latino patients with uncontrolled diabetes (hemoglobin A(1c) [A1C] > or =8.0%) to the study. A research assistant assessed patients on diabetes and medical history, medication list, medication adherence and related habits, health literacy, diabetes knowledge and numeracy, beliefs in benefits of diabetes therapy, depression, social support, and access to care. A bilingual, bicultural health promoter reviewed these assessments and worked with patients through home and clinic visits and telephone calls. The health promoter communicated with a pharmacist to receive assistance in medication management (reconciliation and adjustment). Participants received case management for 6 months. RESULTS: Nine patients were successfully recruited. The mean age was 58 years and mean duration of diabetes was 21 years. Successful collaboration between pharmacists and the health promoter required frequent communication and intense effort to address complex patient barriers. Health promoter contact time, in person, per participant ranged from 0 minutes to 640 minutes, and telephone call time ranged from 27 minutes to 111 minutes during the study period. Eight participants had medication adjustments during the study period, with a maximum of 7 adjustments per participant. Mean hemoglobin A1C declined from an average of 9.6% to 9.0%. Two patients are presented as case studies to describe how the pharmacist-health promoter team functioned. Information was obtained from health promoter records, survey results, and chart reviews. CONCLUSIONS: The pharmacist and health promoter team management of uncontrolled diabetes among Latinos appears to be a feasible approach to improving medication management.