title: More allopurinol is needed to get gout patients < 0.36 mmol/l: a gout audit in the form of a before-after trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, PB 92019 Auckland, New Zealand. b.arroll@auckland.ac.nz
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
authors.forename: Merran
authors.initials: M
authors.lastname: Bennett
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
authors.forename: Dilanka
authors.initials: D
authors.lastname: Hettiarachchi
authors.forename: Cribben
authors.initials: C
authors.lastname: Ben
authors.forename: Ginnie
authors.initials: G
authors.lastname: Shelling
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage*; D019985:Benchmarking; D054869:Clinical Audit; D054521:Cultural Competency; D003937:Diagnosis, Differential; D006073:Gout / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D006074:Gout Suppressants / Q000008:administration & dosage*; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D009520:New Zealand; D010865:Pilot Projects; D014527:Uric Acid / Q000097:blood*; D044465:White People
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol