title: Strategy to improve the request of uric acid in primary care: preliminary results and evaluation through process and outcome appropriateness indicators.
abstract: BACKGROUND
  Alerted by the high rates of request of serum uric acid (UA) in primary care patients, we aimed to design a strategy to improve such an indicator, and to monitor such an intervention through process and outcome appropriateness indicators.
  
  
  METHODS
  To design the strategy, several meetings were held between the Laboratory, Rheumatology and Primary Care. The intervention consisted of discharging UA from two laboratory profiles ("Health Check" and "Rheumatology"), making it only possible to request the test in an individualized manner. To assess the intervention effectiveness, the ratio of UA/glucose requests, the quantity of allopurinol prescription and the resulting economic savings were calculated and compared for pre- and post-intervention 12 month periods.
  
  
  RESULTS
  There was a 70% decrease in the number of UA requests in the post-intervention period, as compared to the pre-intervention interval. The ratio of UA/glucose requests experienced a significant commensurate drop in the post-intervention period (p<0.01). There was a significant reduction in the prescription of allopurinol (p<0.01). From an economic perspective, the strategy resulted in a savings of 8190 €.
  
  
  CONCLUSIONS
  The strategy resulted in a dramatic drop in the number of UA requests and in the prescription of allopurinol. This highlights a likely existence of prior unnecessary treatment of patients with hyperuricemia in the absence of clinical symptoms.
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain; Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain. Electronic address: salinas_mar@gva.es.
authors.forename: Maria
authors.initials: M
authors.lastname: Salinas
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: López-Garrigós
authors.affiliation: Primary Care Center of Mutxamel, Alicante-San Juan Health District, Mutxamel, Alicante, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Asencio
authors.affiliation: Department of Rheumatology, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Batlle
authors.affiliation: Department of Rheumatology, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Minguez
authors.affiliation: Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Lugo
authors.affiliation: Department of Pharmacy, Hospital Universitario de San Juan, San Juan de Alicante, Spain.
authors.forename: Elías
authors.initials: E
authors.lastname: Salinas
authors.affiliation: Department of Radiology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Leiva-Salinas
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D005069:Evaluation Studies as Topic; D006305:Health Status Indicators; D006801:Humans; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D014527:Uric Acid / Q000097:blood*
chemical_list: D001786:Blood Glucose; D014527:Uric Acid; D000493:Allopurinol
keywords: Appropriateness; Gout; Hyperuricemia; Laboratory management; Patient safety; Test request; Uric acid