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  • Impact of pharmacist-led co...
    Cheong, Kah Mun; Sriranganathan, Melonie Kannamma; Lee, Elena Meishan

    Proceedings of Singapore healthcare, 01/2023, Letnik: 32
    Journal Article

    Background The concept of a pharmacist-led collaborative gout clinic is relatively new in Singapore. Objective This study examined the impact of this pilot shared care model on providing dose titration of urate lowering therapy, gout education and patient support to achieve target serum uric acid (sUA) levels. Method A retrospective pre-post study was undertaken to compare outcomes in patients who were started on either allopurinol or febuxostat in the 24 months prior to (Group A: Pre implementation) or 33 months following launch of the collaborative gout clinic (Group B: Post implementation). The collaborative gout clinic comprises of a clinical pharmacist under the supervision of a rheumatologist. Results Of 98 eligible subjects enrolled in our study, there were 50 patients (all prescribed allopurinol) for Group A and 48 patients for Group B (allopurinol n = 29, febuxostat n = 19). Among patients who achieved target sUA level of 360 μmol/L or less at 1 year of drug initiation with use of allopurinol, the median interquartile range, IQR time taken to attain target sUA was shorter in Group B than Group A (111 82–308 days vs. 293 265–414 days, p = 0.016). As compared to Group A, Group B had lesser patients experiencing gout flare (41.3% vs. 70.0%, p = 0.018) and more patients achieving target sUA (75.9% vs. 22.0%, p < 0.001). Mean ± standard deviation, SD daily allopurinol dose to achieve target sUA levels was 276 mg ± 138 mg. Conclusion Our results demonstrate the use of a pharmacist-led collaborative gout clinic may help to achieve better clinical outcomes in gout management.