Gout in primary care: can we improve patient outcomes?

Background Gout is a red flag indicator for cardiovascular disease and comorbidity. Despite this, there are no incentivised treatment protocols and suboptimal management in the primary care setting is common.

Aim Improvement cycles aimed to educate patients, improve uric acid monitoring, and support medication compliance. It was ultimately hoped that these measures would reduce gout flares and GP practice attendance.

Method A computer-based retrospective search at a large inner-city GP practice between January 2014–December 2014 identified 115 patients with gout. Baseline measurements revealed multiple gout related consultations, poor medication compliance, high uric acid levels, and deficiencies in uric acid monitoring. All patients in the cohort received a telephone consultation regarding their gout followed by a diet, lifestyle, and advice sheet in the post. A new gout phlebotomy order set was devised to include full blood count, urea and electrolytes, cholesterol, urate, random blood sugar, and HbA1c. Letters were sent out to arrange for these blood tests in patients who had not received them during the previous 12 months.

Results The improvement cycles contributed towards reduction in uric acid levels from 0.37 to 0.3 (P = 0.14), 20% reduction in patients experiencing one or more gout flares, and 77% reduction in GP related consultations between March 2015 and March 2016 compared to baseline. The proportion of patients fully compliant with taking their urate lowering therapies improved from 63% to 91% (P = 0.0001).

Conclusion The improvement and Plan, Do, Study, Act cycles have demonstrated that simple interventions can be a sustainable way of improving disease control and patient outcomes.