Pharmacists, particularly community pharmacists, are a key member of the primary healthcare team and have a central role in providing education to patients about health conditions and medicines. It is estimated that more than 89% of the US population is within 5 miles of a pharmacy, making pharmacists one of the most easily accessed healthcare team members [11]. Thus, open communication and education between the pharmacy and prescriber communities is essential to provide the most up-do-date and appropriate patient care. However, pharmacists frequently report a lack of information and clinical connection to other healthcare professionals as barriers to providing optimal care to patients[11]. In this study we have demonstrated that pharmacists do not typically use disease management guidelines as standard sources of information, and as such, may not be up to date on the recommendations for gout management. This is somewhat understandable given the wide number of conditions encountered on a daily basis in community pharmacy and the wide number of society guidelines available. For a community pharmacist, it may be much more time efficient to refer to a generalised text such as the BNF or drug-specific information. As such, a dedicated effort must be made by prescribers and professional societies to communicate treatment standards to pharmacists.
The educational gaps for patients living with gout have been well explored in the literature. In addition to inaccurate common beliefs, patients typically report difficulty understanding the use of prophylaxis during the early phase of urate-lowering therapy and are often unaware of optimal treatment goals [12]. These knowledge gaps are not unique to patients and caregivers, education gaps exist for healthcare professionals as well. Here, we demonstrate that to be the case with pharmacists.
The BNF and SPC conveys clear information on colchicine use in the acute phase of gout flares. They also suggest that colchicine can be used for prophylaxis, but pharmacists report that this role of colchicine has been poorly communicated to pharmacy community and that clarity on duration of colchicine prophylaxis is lacking[13]. Furthermore, the phenomenon of legacy prescribing, whereby a short or intermediate-term medications are not appropriately discontinued, is prevalent [14]. Patients, and indeed pharmacists, therefore, may experience confusion as to whether the prescribed colchicine is indeed intended as a prophylaxis or is a legacy prescription that was previously prescribed in case of flare. This confusion can be confounded by lack of clear, definitive statements on updated best practices from national medicine information centre or similar national bodies.
In most countries, pharmacists must undertake continuing professional development (CPD) and typically are open to education that influences and benefits their professional practice [15]. In Ireland, the Pharmacy Act 2007 requires that all pharmacists in Ireland must undertake continuing professional development (CPD). This study acts as a proof of concept and the intervention presented here could be integrated into a CPD for gout management. This would have the benefit of increasing the reach of this information to pharmacists. An extended CPD could also incorporate other important areas for gout management that were beyond the scope of this study, such as lifestyle recommendations, medication selection and treatment of acute gout. We would recommend a co-design approach for this CPD between rheumatologists and pharmacists to ensure the most up to date knowledge is being disseminated to pharmacists in a manner most suited and accessible to practising pharmacists. A co-design approach could also improve the interest and uptake of a gout CPD module by pharmacists [16]. The onus is on the rheumatology community to communicate to pharmacists and other health care providers about up-to-date recommendations for gout management.
We have demonstrated that co-designing an education intervention with pharmacists can be an effective, low-cost way to increase pharmacist knowledge on the management of gout. In this study we assessed a single intervention. Of note, in our study a relatively high proportion of pharmacists that, despite having received the educational intervention, have insufficient knowledge about certain areas of gout management. The intervention was assessed approximately nine months after the training was released onto the pharmacist eLearning platform. The lag time between training and assessment was used to model the real world. However, spaced learning may be beneficial to reinforce education on gout management in the long-term. Thus, periodic review sessions with gout pharmacists on key gout management points could compound learning, although this has yet to be assessed. Distributed or spaced learning may be better for maintaining long-term knowledge, but other obstacles may prevent this approach from being applicable in a real-world scenario [17]. Given the breadth of the community pharmacist’s remit, there is seldom the incentive or feasibility to methodically revisit previously learned materials. This will need to be considered in follow up studies address this approach.
Strengths to this study include the co-design of the intervention with pharmacists and use of pharmacist-run learning platforms to maximise the accessibility of the intervention to the target audience. The limitations are the small sample size relative to the number of pharmacists registered in Ireland. This study focused on a specific issue encountered in practice. There are other relevant management issues related to gout management beyond the scope of this study. Thus, the survey results may not reflect all pharmacists’ knowledge.
