
%0 Journal Article
%A Arroll, Bruce 
%A Bennett, Merran 
%A Dalbeth, Nicola 
%A Hettiarachchi, Dilanka 
%A Cribben, Ben 
%A Shelling, Ginnie 
%T More allopurinol is needed to get gout patients <0.36 mmol/L: a gout audit in the form of a before&#x2013;after trial
%J Journal of Primary Health Care
%D 2009/12/01
%V 1
%N 4
%P 315-318
%K 
%R https://doi.org/10.1071/HC09315
%U https://www.publish.csiro.au/paper/HC09315 
%X AIM: To establish a benchmark for gout control using the proportion of patients with serum uric acid (SUA)<0.36 mmol/L, assess patients&#x2019; 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&#x2013;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 
