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PRECISION

Preventing Complications from Inflammatory Skin, Joint and Bowel Conditions

Project 2: A patient/ rheumatologist/ pharmacist/ dietitian team use electronic communication to better manage gout

 

*Please note: This study is no longer recruiting participants.*

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Scientific study title: Collaborative Care Involving eHealth* to Improve Treatment Adherence and Health Outcomes of Patients with Gout

 

*eHealth refers to the use of technologies to manage information and communications in health care. The use of eHealth practices can facilitate communications between practitioners and patients and allow for better management and sharing of electronic medical records.

 

This was a sub study of the PRECISION: Preventing Complications from Inflammatory Skin, Joint and Bowel Conditions team grant

 

Principal investigator:

Mary De Vera, BSc, MSc, PhD, Research Scientist, Arthritis Research Canada; Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada, Research Scientist, Arthritis Research Canada

 

Start and end date: July 2014 – January 2017

 

Key Findings:  

Our study showed that the collaborative team’s ehealth approach was feasible and effective in managing gout.  We found uric acid levels decreased during the study with over two-thirds of patients hitting target levels by the end of the follow-up period.

 

Why do this research?

Gout is a very painful type of arthritis that occurs when too much uric acid builds up in the body leading to inflammation and deformity in the joints. It affects over one million Canadians and this burden is expected to increase with the aging of the population. Studies have shown that gout is often poorly managed and patients do not always follow their treatment plans and take their medication. As a result, patients often do poorly, suffering from repeated gout attacks, and complications that lead to avoidable emergency department visits and hospitalizations. Research on how to optimize and improve gout care is very limited

 

What was done?

The Virtual Gout Clinic is a collaborative care team for gout involving rheumatology, pharmacy, and dietetics. The clinic takes advantage of eHealth technologies particularly shared access of electronic medical records (EMR).

 

Participants with gout received:

1) regular in person visits with their rheumatologist;

2) monthly medication management telephone calls with the pharmacist; and

3) one phone counselling session with the dietitian.

 

Outcome measures include:

  • Disease activity, functional status, and quality of life as measured through online surveys.
  • Medication adherence and serum uric acid levels assessed via the shared EMR.

 

Who was involved?

We have a team consisting of researchers, eight rheumatologists in four participating practices across British Columbia, a registered dietitian, and a study pharmacist. Those with gout treated by the study rheumatologists are invited to participate. Altogether, 35 individuals with gout have been enrolled in the study and received care within this eHealth-supported collaborative care clinic.

 

Co-Investigators:

Kam Shojania, MD, FRCPC, Clinical Trialist and former Director of Clinical Trials, Arthritis Research Canada; Division Head, Division of Rheumatology and Clinical Professor of Rheumatology, University of British Columbia

 

Carlo Marra, PharmD, PhD, FCSHP, Research Scientist of Pharmacoepidemiology, Arthritis Research Canada; Dean and Professor, School of Pharmacy, University of Otago, Dunedin, NZ

 

Hyon Choi, MD, DrPH, FRCPC, Research Scientist , Arthritis Research Canada; Professor of Medicine, Harvard Medical School Director, Clinical Epidemiology and Health Outcomes, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital;

 

Antonio Avina-Zubieta, MD, MSc, PhD, Senior Research Scientist, Arthritis Research Canada; Associate Professor, Division of Rheumatology, University of British Columbia

 

Alison Kydd, MD, Clinical Assistant Professor, University of British Columbia

 

Milton Baker, MD, FRCPC, Associate Member, Division of Rheumatology, University of British Columbia

 

Who funded this research?

  • Canadian Initiatives for Outcomes in Rheumatology Care (CIORA)
  • Canadian Institutes of Health Research (CIHR)
  • Crohn’s and Colitis Canada

 

Publications:

Howren A, Tsao NW, Choi HK, Shojania K, Kydd A, Friesen R, Avina-Zubieta JA, De Vera MA. eHealth-supported decentralized multidisciplinary care for gout involving rheumatology, pharmacy, and dietetics: Proof-of-concept study. Clin Rheumatol. 2019 Nov 13. DOI: 10.1007/s10067-019-04809-6. [Epub ahead of print].

Howren A, Cox SM, Shojania K, Rai SK, Choi HK, De Vera MA. How patients with gout become engaged in disease management: A constructivist grounded theory study. Arthritis Res Ther. 2018 Jun 1;20(1):110. DOI: 10.1186/s13075-018-1608-x. https://www.ncbi.nlm.nih.gov/pubmed/29859127

Estrada A, Tsao NW, Howren A, Esdaile JM, Shojania K, De Vera MA. Utility of electronic medical records in community rheumatology practice for assessing quality of care indicators for gout: A feasibility study. J Clinical Rheumatol. 2018; 24(2):75-79. DOI:1097/RHU.0000000000000621. https://www.ncbi.nlm.nih.gov/pubmed/29232325

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