Rationale and design of the randomized evaluation of an Ambulatory Care Pharmacist-Led Intervention to Optimize Urate Lowering Pathways (RAmP-UP) Study

摘要

For over a decade, evidence has accumulated that gout patients are not achieving optimal outcomes due, in part, to suboptimal provider and patient behaviors [1-6]. Clinical inertia, defined as the failure to either initiate or appropriately intensify an indicated therapy [7], appears to be commonplace among health care providers prescribing urate lowering therapy (ULT) for gout [1-3]. In 2012, the American College of Rheumatology published gout management guidelines suggesting that patients receiving allopurinol, the most commonly prescribed first-line ULT [2,8], receive gradual dose titration guided by serial serum urate (sUA) measurement [9]. Yet, only one in four patients have sUA assessments within 6 months of ULT initiation and less than one-third undergo ULT dose escalation [1]. Additionally, nonadherence to ULT has been well-documented among gout patients further limiting achievable outcomes [1,4]. For chronic diseases, suboptimal patient and provider medication prescribing and usage patterns may be interdependent suggesting that addressing either in isolation may have a limited impact [10].