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eHealth-supported decentralized multi-disciplinary care for gout involving rheumatology, pharmacy, and dietetics: proof-of-concept study

  • Alyssa Howren
  • Nicole W. Tsao
  • Hyon K. Choi
  • Kam Shojania
  • Alison Kydd
  • Russell Friesen
  • J. Antonio Avina-Zubieta
  • Mary A. De VeraEmail author
Original Article

Abstract

Objective

To conduct quantitative and qualitative evaluation of an electronic health (eHealth)-supported decentralized multi-disciplinary care model for gout involving rheumatologists, pharmacist, and dietitian.

Methods

We conducted a 12-month proof-of-concept study. Gout patients with ≥ 1 flare in the past year and serum urate (SUA) ≥ 360 μmol/L within the previous 2 months were followed by participating community rheumatologists on an as-needed basis, received monthly telephone consults with a pharmacist, and one telephone consult with a dietitian. Healthcare professionals were not co-located but had shared access to the rheumatologists’ electronic medical records (EMR) for remote communication and collaboration. In quantitative evaluation, the primary outcome was the proportion of patients with SUA < 360 μmol/L at 12 months. In qualitative evaluation, we conducted semi-structured interviews with a subset of patients and applied constructivist grounded theory to gather patients’ perspectives.

Results

Overall, 35 gout patients (86% males, mean age 60.9 ± 14.9 years) participated. At 12 months, 72% of patients achieved target SUA < 360 μmol/L. Qualitative analysis of interviews with a subset of 12 patients resulted in two themes: (1) experiences with receiving care, including categories of improved knowledge about gout, receiving personalized support, and knowing someone cares, and (2) practical considerations, including categories of optimizing timing of care and coordination and accessibility.

Conclusion

Our multi-method study shows that a decentralized, multi-disciplinary care for gout involving rheumatology, pharmacy, and dietetics with shared EMR access led to gout patients achieving target SUA. It was well-received by patients who perceived better education about gout and personalized care.

Key Points

We demonstrated the feasibility and impact of an eHealth-supported, decentralized collaborative care model for gout involving rheumatology, pharmacy, and dietetics

Although prior multi-disciplinary models of care for gout have been reported, the novelty of our model is that healthcare providers are not co-located, lending to potential efficiencies and outreach to patients in rural areas

Keywords

Dietetics Gout Models of care Pharmacy Rheumatology 

Notes

Acknowledgments

The authors thank all participants in the study and our collaborators at Plexia Electronic Medical Systems for technical support provided for the study. The authors thank Drs. John Esdaile, Nicole Bauer, David Collins, and Shahin Jamal for their rheumatologic contributions to the study.

Funding information

Dr. Mary De Vera is a recipient of a Scholar Award from the Michael Smith Foundation for Health Research and holds a Tier 2 Canada Research Chair.

Ms. Howren was supported by a Master’s Award from the Canadian Institutes of Health Research—Canada Graduate Scholarships—Master’s (CGS-M) Program for her work related to this study.

Dr. Avina-Zubieta is a recipient of Scholar Award from the Michael Smith Foundation for Health Research and is the BC Lupus Research Scholar.

This study was supported by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care and a team grant titled, ‘PRECISION: Preventing Complications from Inflammatory Skin, Joint and Bowel Conditions’ (FRN#THC-135235) from the Canadian Institutes of Health Research.

Compliance with ethical standards

Ethics approval and consent to participate

This study was reviewed and approved by the University of British Columbia Clinical Research Ethics Board (H14-01465) and Behavioural Research Ethics Board (H16-02061). Written consent was received from all study participants.

Consent for publication

Not applicable.

Competing interests

HKC reports grants from AstraZeneca and consulting fees from Takeda, Selecta, and Horizon outside of the submitted work.

The other authors have disclosed no conflicts of interest.

Supplementary material

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ESM 1 (PNG 306 kb)

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
  2. 2.Arthritis Research CanadaRichmondCanada
  3. 3.Collaboration for Outcomes Research and EvaluationVancouverCanada
  4. 4.Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonUSA
  5. 5.Faculty of Medicine, Department of Medicine, Division of RheumatologyUniversity of British ColumbiaVancouverCanada
  6. 6.Providence HealthVancouverCanada

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