eHealth Supported Decentralized Multi-Disciplinary Care for Gout Involving Rheumatology, Pharmacy, and Dietetics : Proof-of-concept Study Howren, Alyssa; Tsao, Nicole W.; Choi, Hyon; Shojania, Kam; Kydd, Alison; Friesen, Russell; Avina-Zubieta, J. Antonio; De Vera, Mary
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. Health care 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 sub-set 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.
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