title: Improved management of acute gout during hospitalization following introduction of a protocol.
abstract: OBJECTIVE
  To determine whether implementation of a protocol to manage in-hospital acute gout has improved the care of patients by non-rheumatologists.
  
  
  METHODS
  Two systematic case-file reviews were performed to determine the management of acute gout in all episodes occurring in hospitalized patients before (April 2005-December 2006) and after (November 2008-September 2009) introduction of a protocol for acute gout management in a tertiary referral hospital. The protocol targeted non-rheumatologists with primary intentions to continue baseline anti-gout medications on admission, prevent inappropriate prescriptions of colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) and allopurinol in the hospital, encourage invitations for assistance by rheumatology, and promote combination therapy in cases of severe gout.
  
  
  RESULTS
  Excluding patients under the primary care of a rheumatologist, 118 cases of acute gout occurring during hospitalization were reviewed before and 89 cases after introduction of the gout protocol. Post-protocol, there was a significant increase in continuation of baseline allopurinol (P = 0.01), significantly less inappropriate prescriptions of colchicine (P < 0.001) and allopurinol (P = 0.02), and a fall in the occurrence of overall adverse events (P = 0.01). After protocol introduction, when monotherapy was prescribed, NSAID usage declined and prednisone usage increased (P = 0.04), but there was no significant shift toward combination therapy use. Delays from symptom recognition to treatment were significantly reduced (P < 0.001), and rheumatology involvement significantly increased from 33.9% pre-protocol to 51.7% post-protocol.
  
  
  CONCLUSIONS
  Following introduction of a hospital-wide protocol for acute gout management, there have been significant improvements in the management of acute gout by non-rheumatologist clinicians.
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia.
authors.forename: Narainraj
authors.initials: N
authors.lastname: Kamalaraj
authors.forename: Sonali R
authors.initials: SR
authors.lastname: Gnanenthiran
authors.forename: Theepan
authors.initials: T
authors.lastname: Kathirgamanathan
authors.forename: Geraldine M
authors.initials: GM
authors.lastname: Hassett
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Gibson
authors.forename: H Patrick
authors.initials: HP
authors.lastname: McNeil
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006073:Gout / Q000175:diagnosis / Q000188:drug therapy*; D006074:Gout Suppressants / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015397:Program Evaluation; D058996:Quality Improvement; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006074:Gout Suppressants