Facilitating equitable prevention and management of gout for Maori in Northland, New Zealand, through a collaborative primary care approach

Abstract

Introduction: The Gout Stop Programme was developed for primary care in Northland, New Zealand, to address inequitable health outcomes for Maori 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 Kaiawhina (community support worker) provided education and support to patients and whanau (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 Maori and Pacific patients. The completion rate was 55% in this group and 84% for the non-Maori and non-Pacific group. In the Maori 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-Maori/non-Pacific group, these rates were 51% and 19% respectively. Following programme completion, 68% of Maori and Pacific patients and 65% of non-Maori 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.