Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice.
BACKGROUND
Gout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce cardiovascular disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the European League Against Rheumatism (EULAR) have published guidance regarding the management of gout, thereby providing standards against which performance can be measured. This audit was designed to assess the extent to which patients diagnosed with gout in one primary care medical practice in North Staffordshire, UK, are managed in accordance with current best practice guidelines, and to identify strategies for improvement where appropriate.


METHODS
Audit criteria were derived from the EULAR and BSR/BHPR guidelines; standards were set arbitrarily, but with consideration of patient comorbidity and other factors which may influence concordance. An electronic search of the practice records was performed to identify adults with a diagnosis of gout. Medical record review with a descriptive analysis was undertaken to assess the extent to which medical management adhered to the predefined standards.


RESULTS
Of the total ≥18 year-old practice population (n = 8686), 305 (3%) patient records included a diagnosis of gout. Of these, 74% (n = 226) had an electronic record of serum uric acid (SUA), and 11% (n = 34) and 53% (n = 162) a measure of estimated glomerular filtration rate (eGFR) ever and serum glucose since diagnosis respectively. 34% (n = 105) of patients had ever taken urate-lowering therapy with 25% (n = 77) currently prescribed this at the time of data extraction. Dose adjustment and monitoring of treatment according to SUA was found to be inadequate. Provision of lifestyle advice and consideration of comorbidities was also lacking.


CONCLUSIONS
The primary care management of gout in this practice was not concordant with national and international guidance, a finding consistent with previous studies. This demonstrates that the provision of guidelines alone is not sufficient to improve the quality of gout management and we identify possible strategies to increase guideline adherence.
Research Institute for Primary Care & Health Sciences, Keele University, Keele, ST5 5BG, Staffordshire. e.cottrell@keele.ac.uk.
Elizabeth
E
Cottrell
Valerie
V
Crabtree
John J
JJ
Edwards
Edward
E
Roddy
D000368:Aged; D001786:Blood Glucose; D004035:Diet Therapy / Q000706:statistics & numerical data*; D019468:Disease Management; D005260:Female; D005919:Glomerular Filtration Rate; D006073:Gout / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D033461:Hyperuricemia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D007677:Kidney Function Tests / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D006113:United Kingdom; D014527:Uric Acid / Q000097:blood
D001786:Blood Glucose; D006074:Gout Suppressants; D014527:Uric Acid