If you would like to view a PDF version of the bulletin, click here.
The jury is in – usual gout care isn’t working well, especially for Māori and Pacific peoples, who are disproportionately affected by this common disorder.1,2 What potential tools are readily available to reduce gout harm? Specific clinician actions!
A Māori or Pacific person aged between 20 and 40 presents with joint pain? Consider gout a potential cause. Māori and Pacific peoples are, respectively, two and three times more likely to get gout and at a younger age than non-Māori, non-Pacific peoples.3
Contemplating an NSAID? While effective for gout, repeated exposure is not without risk, and use is high, especially for Māori and Pacific peoples.3 Before writing/dispensing another NSAID prescription for gout, ask yourself – would this person benefit from long-term urate-lowering therapy (ULT) now?
Peoples’ capacity to engage, accept and self-manage their gout varies significantly.2
Patients may blame themselves for their gout and feel whakamā (shame), holding on to outdated yet strong beliefs their gout is caused by overindulgence in food/drink. Raise awareness of genetic predisposition to gout in Māori and Pacific peoples; this can reduce whakamā and encourage treatment programme participation.1,2 Talk about food/drink as triggers only.
Daily, life-long treatment can be challenging and hard to accept. Support patients in engagement, and share decision-making.
Be aware Māori and Pacific peoples are less likely to receive regular ULT than others.3 Pharmacists, especially, have an opportunity to detect irregular ULT dispensing. Be alert to the person with joint pain or repeated purchases of NSAIDs – reach out to prescribers.
Dynamically building patient knowledge and skills through health literacy can overcome barriers to care.1,2 Hone your communication skills and provide consistent messages and individualised support. Encourage treatment persistence through trustworthy and relatable information delivery.2
For health literacy resources click here and visit Arthritis New Zealand at www.arthritis.org.nz for gout educator assistance.
Usual gout care is variable, and different management approaches are needed, particularly in Māori and Pacific peoples.1,2
To help further reduce gout harm in Māori and Pacific peoples, healthcare providers can:
1. BPACnz. Managing gout in primary care. August 2021. https://bpac.org.nz/2021/docs/gout2021.pdf
2. Andrews S, Gasparini J, Henderson G. Evaluation of Gout Stop and Owning My Gout management programmes. A final report for Arthritis New Zealand and its partners. 2020. tinyurl.com/goutprog
3. Health Quality & Safety Commission New Zealand. Atlas of Healthcare Variation: Gout. Updated November 2021. https://www.hqsc.govt.nz/our-data/atlas-of-healthcare-variation/gout/
This editable PDF helps you to delve into the EPiC data, contemplate your prescribing, reflect on your current practice, and set goals and actions.
*New audit section*
An additional audit/CQI section allows you or your practice team to repeat the process, completing activities that may be used for Foundation Standard or the Cornerstone CQI or Equity modules.