Gout is an equity issue. The suffering this condition causes is avoidable and differences between people and populations can be remedied.
The Health Quality & Safety Commission's Atlas of Healthcare Variation gout domain shows the number of people affected by gout is increasing. Māori and Pacific peoples are experiencing five times as many hospital admissions when compared to non-Māori/non-Pacific people. At least 40 percent of Māori males suffer from gout– and this is thought to be an underestimate as many may not present to their doctor. If they do, may not be classified as having gout.
This inequity spurred Papakura Marae Health Clinic and National Hauora Coalition (NHC) into taking action. Their gout management improvement project is called Oranga Rongoā.
'Oranga Rongoā is one of the three successful initiatives supported by the Commission’s Whakakotahi programme,' says Dr John Wellingham, Chair of the Commission’s Primary Care Expert Advisory Group. 'The Commission provides advisors, support, training and $6000 to offset costs; the project teams provide the local knowledge and expertise, engagement with community and the collective drive to make a difference.'
The Papakura Marae Health Clinic serves 3,200 people of whom 95 percent are Māori or Pacific. Many of their enrolled population live in the most deprived neighbourhoods of South Auckland.
For prescribing pharmacist and project lead, Leanne Te Karu, this project is about implementing a multidimensional collaborative approach premised on health equity. At Papakura, we are focussed on health outcomes and recognise we need to challenge the status quo of current heath model delivery. The Commission’s quality improvement advisors are helping to build some capacity around quality improvement monitoring and implementation which will be transportable to other initiatives.
'Poverty is one of the major drivers of ill health in the population we serve.' says nurse lead Pauline Fitzgerald. 'The health service can only go so far but with our integrated marae service leadership we can provide support, advocacy and innovation. Knowing our community and having a personal rapport/respect promotes strong engagement with Whanau on their health journey.'
The team feels supported by its e-platform Mohio, a built-in decision support system that helps capture key measures to track patient care. The first step for the team has been to identify every patient who has been classified as having gout or those who may not be classified but have previously been prescribed allopurinol or colchicine.
Having carefully diagnosed the extent of the problem, the team is working towards developing change ideas to test via plan-do-study-act cycles.
As GP Dr Martin Davis says, 'We are thinking outside the box to address inequities. For example, if patients don’t have the means to come to see us, we go out and collect them. Our aim is to reduce serum urate levels, reduce gout flare-up and reduce hospital and ED visits. Hopefully in a few months we can share our experiences and learnings.'