Background Sub-optimal quality of care for gout, the most common inflammatory arthritis, has called for novel models to improve care and outcomes of patients.
Objectives Our objective was to evaluate the feasibility of the “Virtual Gout Clinic Study” (VGCS) a collaborative approach to gout management involving rheumatology, pharmacy, and dietetics that take advantage of eHealth, namely, shared access of electronic medical records (EMRs), to support this unique, decentralized model of care.
Methods Design: We conducted a 1-year, proof-of-concept, longitudinal observational study with a target of 30 patients. Eligibility: Patients with gout were eligible if they were: 1) seen in 1 of 4 rheumatology practices with 8 rheumatologists participating across British Columbia, Canada; 2) experienced ≥1 flare in the past year; 3) have a serum uric acid (SUA) level ≥360 μmol/L within the previous 2 months. Follow-up: Within the VGCS, patients receive follow-up with their rheumatologist on an as needed-basis, monthly telephone consults from the study pharmacist, and 1 telephone consult with the dietician. In this decentralized model of care, health care professionals are not co-located but have access to the patient's EMR to facilitate remote communication and collaboration. Outcomes: Prospective data was collected at baseline, 3, 6, and 12 months. The primary outcome measure was SUA at 12-months, specifically below recommended target level of 360 μmol/L. Secondary outcomes included patient reported outcome measures including the Compliance Questionnaire Rheumatology, Health Assessment Questionnaire Disability Index, and EQ-5D, as well as information on interventions provided within the VGCS.
Results Overall, 33 individuals with gout participated in the VGCS. There were 22 males (88%) and mean age was 60.8±15.3 years. 29, 28, and 25 patients have completed follow-up at 3, 6, and 12 months respectively. At baseline, 22 (67%) patients were prescribed urate-lowering therapy (ULT; 21 with allopurinol and 1 with febuxostat). The remaining 11 patients initiated ULT during the study period. Figure 1 shows mean SUA decreased over baseline, 3, 6, and 12 months from 451 μmol/L, 367 μmol/L, 356 μmol/L, and 364 μmol/L, respectively, with 67% of patients having SUA <360 μmol/L at 12 months. A total of 126 pharmacist and 24 dietician consults have been provided. Pharmacist interventions included: uptritration of allopurinol dosage for 15 patients, restarting of ULT for 4 non-adherent patients, discontinuation of unnecessary medications for 12 patients, and renewals of prescription medications using solely electronic communications for 4 patients.
Conclusions These findings provide evidence for the feasibility and effectiveness of the VGCS. With respect to feasibility, we successfully established the shared EMR framework between rheumatologists and study pharmacist and dietitian and demonstrated utility with respect to facilitating communication and collaborative care between health care providers and providing outcomes data. With respect to effectiveness, findings show declining SUA over follow-up with over two-thirds of patients achieving target at the end of follow-up.
Disclosure of Interest None declared