More allopurinol is needed to get gout patients <0.36 mmol/L: a gout audit in the form of a before–after trial

Abstract

AIM: To establish a benchmark for gout control using the proportion of patients with serum uric acid (SUA)<0.36 mmol/L, assess patients’ understanding of their preventive medication and trial a mail and phone intervention to improve gout control. METHODS: Patients clinically diagnosed with gout and baseline SUAs were identified in two South Auckland practices. A mail and phone intervention was introduced aimed at improving the control of gout. Intervention #1 took place in one practice over three months. Intervention #2 occurred in the other practice four to 16 months following baseline. RESULTS: No significant change in SUA from intervention #1 after three months. The second intervention by mail and phone resulted in improvement in SUA levels with a greater proportion of those with SUA <0.36 mmol/L and the difference in means statistically significant (p=0.039 two-tailed paired t-test). Benchmarking for usual care was established at 38–43% SUA <0.36 level. It was possible to increase from 38% to 50%. Issues relating to gout identified included lack of understanding of the need for long-term allopurinol and diagnosis and management for patients for whom English is not their first language. STRATEGIES FOR IMPROVEMENT: (1) Community workers who speak Pacific languages may assist GPs in communicating to non-English speaking patients. (2) Alternative diagnoses should be considered in symptomatic patients with prolonged normouricaemia. (3) GPs should gradually introduce allopurinol after acute gout attacks, emphasising importance of prophylaxis. (4) A campaign to inform patients about benefits of allopurinol should be considered. (5) A simple one keystroke audit is needed for gout audit and benchmarking. (6) GP guidelines for gout diagnosis and management should be available. KEYWORDS: Gout; uric acid; clinical audit; benchmarking; family practice