Gout Prevention Project. Simplifying Gout Prevention Management for GPs and Patients

Transcription

1 Gout Prevention Project Simplifying Gout Prevention Management for GPs and Patients

2 Gout Prevalance 2

3 Gout Management primary care level 52.8% of PCP provided optimal medication treatment for acute attack 3.4% of PCPs would appropriately treat inter-critical gout in the setting of CKD 16.7% provided optimal care for chronic tophaceous gout Primary Care and ER Physicians are first line for acute gouty attacks 3 Harrold LR, et al. Rheumatology, 2013.

4 Objective of the Project This open evaluation had the following objectives: To evaluate the treatment of acute gout and the initiation of preventative treatment in a selected group of patients according to a specific treatment regime referred to as the Gout Starter Pack. To assess the process of providing medication according to a prescription written for a Gout Starter Pack and patient adherence to this regimen.

5 Evaluation Population Inclusion Criteria: Clinical diagnosis of acute gout attack Vital signs within range (Temperature<37 0 C, BP systolic >100 mmhg, Pulse<100 beats/minute) Patient can move joint in spite of pain Attacks 2 per annum Exclusion criteria: (Refer to Rheumatologist) Doubt about diagnosis Septic Arthritis Avoid treatment with colchicine if egfr very low

6 Evaluation Criteria Clinical condition of patient: Tolerance of allopurinol treatment Resolution of gout Serum uric acid levels monitored as follows: In the last week of Gout Starter Pack regimen (day 85 91) Patient education and adherence: Patient understanding of treatment necessary for acute gout attack Patient understanding of need for allopurinol on long-term basis. Treatment success was based on: Serum uric acid levels 0.36 mmol/l Patient on a maintenance dose of allopurinol.

7 In a nutshell Set up Acute Gout Starter Packs in Rx One script covers the acute attack and up titration over next 3 months At presentation the pharmacist is given a lab form for check UA at end of last pack Over this time the patient is seen 4 times by the pharmacist and has Arthritis NZ Gout Educator contact the patient The results of this process are encouraging

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11 Acute Gout Starter Packs GOUT STARTER PACK egfr > 60 Sig: Prednisone 40mg 4/7, 20mg 4/7, 10mg 3/7, 5mg 3/7. Colchicine 500mcg bd 3/12. Allopurinol 100mg daily 1/12, 200mg daily 1/12, 300mg daily 1/12. Mitte: 1 GOUT STARTER PACK egfr Sig: Prednisone 40mg 4/7, 20mg 4/7, 10mg 3/7, 5mg 3/7. Colchicine 500mcg once daily 3/12. Allopurinol 50mg daily 1/12, 50mg daily 1/12,100mg daily 1/12. Mitte: 1 GOUT STARTER PACK egfr < 30 Sig: Prednisone 40mg 4/7, 20mg 4/7, 10mg 3/7, 5mg 3/7. Colchicine 500mcg every other day 3/12. Allopurinol 50mg every other day 1/12, 50mg every other day 1/12, 100mg daily 1/12. Mitte: 1

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14 Interim Results Overall group n=20 Completed n=14 Success n = 9 Titration n = 5 Withdrawn n=4 On-going n = 2 Age (years) Mean Range Gender Male Female 15 (75%) 5 (25%) 10 (71.4%) 4 (28.6%) 7 (77.8%) 2 (22.2%) 3 (60%) 2 (40%) 3 (75%) 1 (25%) 2 (100%) Ethnicity NZ Maori NZ European European

15 Patients Requiring Up Titration Patient No Age (yrs) Gender M M F M F Ethnicity European NZ Maori NZ European NZ European NZ European Treatment Option Serum uric acid level Day 0 Day Uric acid level change Any intolerance to medication No No No No No Treatment Success No Titration No Titration No Titration No Titration No Titration Comments Rx: Allopurinol 150mg daily Colchicine Rx; Allopurinol 400mg daily Colchicine Rx; Allopurinol 200mg daily Colchicine Rx; Allopurinol 400mg daily Colchicine Rx; Allopurinol 200mg daily Colchicine

16 Patients Withdrawn from Patient No 6 Evaluation Age (yrs) Gender M M M F Ethinicity NZ Maori NZ European NZ European NZ Maori Treatment Option Blister pack 1 Stopped - blood glucose rising Collected Only 6 days Collected Blister pack 2 Collected Collected Collected Patient declined Blister pack 3 Collected late Collected - - Blister pack 4 Rx Did not collect Patient hospitalized - - Uric acid level Drop to 0.29 Any intolerance to medication Yes Prednisone No Yes -Prednisone keeps patient awake Nil of note

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18 Amended Starter Packs GOUT STARTER PACK egfr > 60 Sig: Prednisone 40mg 4/7, 20mg 4/7, 10mg 3/7, 5mg 3/7. Colchicine 500mcg bd 3/12. Allopurinol 100mg daily 1/12, 200mg daily 1/12, 300mg daily 1/12. Mitte: 1 GOUT STARTER PACK egfr Sig: Prednisone 40mg 4/7, 20mg 4/7, 10mg 3/7, 5mg 3/7. Colchicine 500mcg once daily 3/12. Allopurinol 50mg daily 1/12, 100mg daily 1/12,150mg daily 1/12. Mitte: 1 GOUT STARTER PACK egfr < 30 Sig: Prednisone 40mg 4/7, 20mg 4/7, 10mg 3/7, 5mg 3/7. Colchicine 500mcg every other day 3/12. Allopurinol 50mg every other day 1/12, 50mg daily 1/12, 100 mg daily 1/12. Mitte: 1

19 Simple Messages 1.Gout is not only a pain in your toe; it's a WAKE UP call to take care of your heart, health and wellbeing. 2.Gout is not cured, even when the pain goes away, but lifestyle changes and medication such as allopurinol can stop gout's bad effects by hitting the target - uric acid less than Your genes play an important part in gout, it is not just your diet

20 Rheumatologist Message Doses above recommended dose are effective for lowering sua with few adverse events Patients with renal impairment tolerated allopurinol doses higher than CrCl-based doses and achieved sua <0.36 Monitor sua regularly and treat-to-target sua <0.36 Stamp LK, et al. Arthritis Rheum