• Ted R Mikuls, T Craig Cheetham, Gerald D Levy, Nazia Rashid, Artak Kerimian, Kimberly J Low, Brian W Coburn, David T Redden, Kenneth G Saag, P Jeffrey Foster, Lang Chen, and Jeffrey R Curtis.
• Division of Rheumatology, University of Nebraska Medical Center and Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Neb. Electronic address: tmikuls@unmc.edu.
• Am. J. Med. 2019 Mar 1; 132 (3): 354361354-361.

PurposeThe purpose of this study was to test a pharmacist-led intervention to improve gout treatment adherence and outcomes.MethodsWe conducted a site-randomized trial (n=1463 patients) comparing a 1-year, pharmacist-led intervention to usual care in patients with gout initiating allopurinol. The intervention was delivered primarily through automated telephone technology. Co-primary outcomes were the proportion of patients adherent (proportion of days covered ≥0.8) and achieving a serum urate <6.0 mg/dl at 1 year. Outcomes were reassessed at year 2.ResultsPatients who underwent intervention were more likely than patients of usual care to be adherent (50% vs 37%; odds ratio [OR] 1.68; 95% confidence interval [CI] 1.30, 2.17) and reach serum urate goal (30% vs 15%; OR 2.37; 95% CI 1.83, 3.05). In the second year (1 year after the intervention ended), differences were attenuated, remaining significant for urate goal but not for adherence. The intervention was associated with a 6%-16% lower gout flare rate during year 2, but the differences did not reach statistical significance.ConclusionsA pharmacist-led intervention incorporating automated telephone technology improved adherence and serum urate goal in patients with gout initiating allopurinol. Although this light-touch, low-tech intervention was efficacious, additional efforts are needed to enhance patient engagement in gout management and ultimately to improve outcomes.Copyright © 2018 Elsevier Inc. All rights reserved.

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