{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:20:37Z","timestamp":1787498437900,"version":"build-2736575974"},"reference-count":42,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T00:00:00Z","timestamp":1590969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Urate\u2010lowering therapy (ULT) is effective in gout, but suboptimal management with wide variability in dose escalation remains widespread. We protocolized dose escalation of ULT to improve gout management. The aim was to reduce time to achieve target serum urate (SU) &lt;360\u00a0\u00b5mol\/L.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Process improvement tools were used to identify underlying causes of prolonged time to target SU. We designed a nurse\u2010led telemedicine intervention for dose escalation of ULT. Patients with gout with SU \u2265360\u00a0\u00b5mol\/L meeting indications for ULT at a single institution were recruited. Exclusion criteria were estimated glomerular filtration rate &lt;30\u00a0mL\/min, pregnancy, cognitive impairment and poor mobility. A nurse\u2010led telemedicine clinic was set up to perform patient education, monitoring of adverse events and drug escalation. We partnered with primary healthcare centers for routine blood tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From July 2016 to December 2017, 127 patients were recruited. Median time to target SU was 19.0\u00a0weeks (interquartile range [IQR] 11.0\u201031.0). Median dose of allopurinol was 300\u00a0mg\/d (IQR 200\u2010400) in normal renal function and lower in renal impairment. Median telemedicine calls required to achieve target SU was 2 (IQR 1\u20103). No patient was hospitalized for gout flares. Two patients had adverse drug reactions, one required cessation of allopurinol for rash with eosinophilia, the other had self\u2010resolving ulcers and allopurinol was continued. Lower baseline SU and number of gout flares were associated with attainment of target SU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A nurse\u2010led telemedicine for gout care is effective and safe. Our results affirm the utility of telemedicine in increasing access to care and lower healthcare utilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1756-185x.13855","type":"journal-article","created":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T21:06:22Z","timestamp":1591045582000},"page":"1136-1144","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["A nurse\u2010led, rheumatologist\u2010assisted telemedicine intervention for dose escalation of urate\u2010lowering therapy in gout"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0121-5487","authenticated-orcid":false,"given":"Kee Fong","family":"Phang","sequence":"first","affiliation":[{"name":"Division of Rheumatology Department of Medicine National University Hospital National University Health System Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2973-0798","authenticated-orcid":false,"given":"Amelia","family":"Santosa","sequence":"additional","affiliation":[{"name":"Division of Rheumatology Department of Medicine National University Hospital National University Health System Singapore"},{"name":"Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette P. L.","family":"Low","sequence":"additional","affiliation":[{"name":"Division of Rheumatology Department of Medicine National University Hospital National University Health System Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela S. H.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Medicine Department of Medicine National University Hospital National University Health System Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi Wei","family":"Khong","sequence":"additional","affiliation":[{"name":"Department of Surgery Singapore General Hospital Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8227-6016","authenticated-orcid":false,"given":"Anita Y. 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