Background/Purpose: Effective treatment for recurrent gout has been hampered by a number of problems including outdated treatment approaches, a failure to treat to target, and poor medication adherence by patients. To address these shortcomings, we set up referral-based gout management clinic and made it available to primary care physicians at a single Kaiser Permanente Medical Center. Patients deemed appropriate for uric acid lowering treatment were referred by their primary care physicians to the clinic. 

Methods: The gout management clinic is a pharmacist-staffed, protocol-based program. The pharmacist, under the supervision of a Board Certified Rheumatologist, initiates and/or adjusts urate-lowering medications and monitored lab parameters and clinical course. The protocol employs standard gout medications (including medicatons to prevent and treat gout flares) and laboratory monitoring to achieve and maintain a serum uric acid (SUA) level of 6.0 or less. Patients are monitored until a target SUA ismaintained for at least 3 months prior to discharge from the clinic.  

Results: Results for the first 100 consecutive patients enrolled in this ongoing clinic are reported here.  To date, a SUA of 6.0 or less has been achieved in 67 patients, and no serious adverse reactions have been seen.  The mean pre-treatment SUA was 9.3+/- 1.9 mg/dl, and the average (most recent or final) SUA with treatment is 5.9 +/-1.4 mg/dl   .  Thirty-five patients have already completed the program and have been discharged back to their primary care physicians. Of these, 29 were on allopurinol at a mean dose of 314 mg/day.  (Range 100-750 mg).  The remaining patients, were on febuxostat (3 patients and probenecid (2 patients).

Conclusion: These results show that recurrent gout can be effectively and safely managed by a protocol based population management program. This approach was efficient and required a minimal time commitment on the part of the supervising rheumatologist.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/feasibility-of-using-a-pharnacist-based-gout-management-clinic-to-improve-serum-uric-acid-in-gout-patients-an-a-large-prepaid-health-plan/