Facilitating equitable prevention and management of gout for Māori in Northland, New Zealand, through a collaborative primary care approach
Aniva Lawrence 1 7 , Sharon Scott 1 , Fabio Saparelli 2 , Georgina Greville 3 , Andrew Miller 4 , Andrea Taylor 5 , Peter Gow 61 Manaia Primary Health Organisation and Te Tai Tokerau Primary Health Organisation, PO Box 1878, Whangarei 0140, New Zealand
2 School of Medicine, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
3 Department of Rheumatology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
4 Bush Road Medical Centre, PO Box 4320, Kamo, Whangarei 0112, New Zealand
5 Northland District Health Board, Private Bag 9742, Whangarei 0148, New Zealand
6 Rheumatologist, Counties Manukau District Health Board, Private Bag 94052, South Auckland Mail Centre Manukau 2240, New Zealand
7 Corresponding author. Email: AnivaL@manaiapho.co.nz
Journal of Primary Health Care 11(2) 117-127 https://doi.org/10.1071/HC18082
Published: 18 July 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: The Gout Stop Programme was developed for primary care in Northland, New Zealand, to address inequitable health outcomes for Māori and Pacific people with gout.
AIM: The aim of the programme was to make it easier for clinicians to prescribe urate-lowering treatment, facilitate patient adherence through education and support, and reduce barriers to gout prevention and long-term management.
METHODS: From 2015 to 2017, patients with acute gout who met inclusion criteria were prescribed treatment according to a ‘Gout Stop Pack’ option, based on renal function and diabetes status. Patients were monitored by community pharmacists. Gout educators and a Gout Kaiāwhina (community support worker) provided education and support to patients and whānau (families). Patient completion of the programme and outcomes, according to target serum urate level, were recorded. Patient experience was documented using a questionnaire and rating scale.
RESULTS: In total, 160 clinicians prescribed therapy at 887 patient presentations; 71% were Māori and Pacific patients. The completion rate was 55% in this group and 84% for the non-Māori and non-Pacific group. In the Māori and Pacific group, 40% reached the target serum urate level (≤0.36 mmol L-1) in 91 days, and 26% required further titration. In the non-Māori/non-Pacific group, these rates were 51% and 19% respectively. Following programme completion, 68% of Māori and Pacific patients and 65% of non-Māori and non-Pacific patients continued to take allopurinol. The 21 patients interviewed rated the programme as excellent or very good.
DISCUSSION: Culturally appropriate education and support for patients and the primary care team was essential. Collaboration between prescribers, community pharmacists and support workers reduced barriers to initiating prevention and long-term urate-lowering treatment and urate testing in this high-needs gout population.
KEYwords: Gout; medications; blood testing; primary health care; Māori health services; Pacific communities
References
[1] Doherty M, Jansen T, Nuki G, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012; 71 1765–70.| 22863577PubMed |
[2] Roddy E, Zhang W, Doherty M. The changing epidemiology of gout. Nat Clin Pract Rheumatol. 2007; 3 443–9.
| The changing epidemiology of gout.Crossref | GoogleScholarGoogle Scholar | 17664951PubMed |
[3] Health Quality and Safety Commission. Atlas of Healthcare Variation. Gout, 2018. [cited 2018 October 01]. Available from: https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/atlas-of-healthcare-variation/gout/
[4] Krishnan E, Lessov-Schlaggar CN, Krasnow RE, et al. Nature versus nurture in gout: twin study. Am J Med. 2012; 125 499–504.
| Nature versus nurture in gout: twin study.Crossref | GoogleScholarGoogle Scholar | 22365026PubMed |
[5] Merriman TRDalbeth NJohnson RJ.
[6] Arroll B. Treating acute gout and starting prevention in 7 minutes. Goodfellow Learning Site; 2015. [cited 2015 May 05]. Available from: https://www.goodfellowunit.org
[7] Goldfien R, Pressman A, Jacobson A, et al. A pharmacist-staffed, virtual gout management clinic for achieving target serum uric acid levels: a randomized clinical trial. Perm J. 2016; 20 15–234.
| 27352414PubMed |
[8] Phone D.. Owning My Gout – A Pharmacist-led collaborative gout management model at Counties Manukau DHB. Int J Integrat Care 2017; 18 A38.1–8.
[9] Statistics New Zealand. 2013 Census QuickStats about a place: Northland Region. [cited 2019 February 03]. Available from: https://www.archive.stats.govt.nz/Censerum urates/2013-censerum urates/profile-and-serum uratemmary-reports/quickstats-about-a-place.aspx
[10] Spencer K, Carr A, Doherty M. Patient and provider barriers to effective management of gout in general practice: a quantitative study. Ann Rheum Dis. 2012; 71 1490–95.
| Patient and provider barriers to effective management of gout in general practice: a quantitative study.Crossref | GoogleScholarGoogle Scholar | 22440822PubMed |
[11] Horsburgh S, Norris P, Becket G, et al. Allopurinol use in a New Zealand population: prevalence and adherence. Rheumatol Int. 2014; 34 963–70.
| Allopurinol use in a New Zealand population: prevalence and adherence.Crossref | GoogleScholarGoogle Scholar | 24390636PubMed |
[12] To Stop Gout booklet. Auckland: Workbase Education Trust; 2014.
[13] Gout Stop 2016 - Interviews with Georgia Grant-Mackie and Dr Aniva Lawrence. Whangarei: Northland District Health Board; 2016. [cited 2018 January 12]. Available from: https://www.youtube.com/watch?v=svyrFaUHPx8
[14] Dalbeth N, House ME, Horne A, et al. The experience and impact of gout in Māori and Pacific people: a prospective observational study. Clin Rheumatol. 2013; 32 247–51.
| The experience and impact of gout in Māori and Pacific people: a prospective observational study.Crossref | GoogleScholarGoogle Scholar | 23114632PubMed |
[15] Te Karu L, Bryant L, Elley CR. Maori experiences and perceptions of gout and its treatment: a kaupapa Māori qualitative study. J Prim Health Care. 2013; 5 214–22.
| Maori experiences and perceptions of gout and its treatment: a kaupapa Māori qualitative study.Crossref | GoogleScholarGoogle Scholar | 23998172PubMed |
[16] Sarawate CA, Brewer KK, Yang W, et al. Gout medication treatment patterns and adherence to standard of care from a managed care perspective. Mayo Clin Proc. 2006; 81 925–34.
| Gout medication treatment patterns and adherence to standard of care from a managed care perspective.Crossref | GoogleScholarGoogle Scholar | 16835972PubMed |
