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Management of gout in a South Auckland general practice
1Aberdeen Royal Infirmary, Aberdeen, Scotland. esther.reaves@nhs.net.
Insights
Gout management has worsened, with rising serum uric acid levels in patients. Annual testing and managing cardiovascular risks are crucial for better patient outcomes.
Area of Science:
- Rheumatology
- Public Health
- Cardiology
Background:
- Gout prevalence is highest among Maori and Pacific populations in New Zealand.
- Counties Manukau District Health Board (CMDHB) serves the largest Maori and Pacific population.
- A CMDHB study indicated a significant overlap between gout and cardiovascular disease risk.
Purpose of the Study:
- To evaluate changes in gout control over time at a specific clinic.
- To assess the management of cardiovascular risk factors in gout patients.
Main Methods:
- A repeat audit of serum uric acid levels in gout patients.
- Scheduling follow-up appointments for abnormal uric acid results.
Main Results:
- Mean serum uric acid levels have increased since a 2009 audit, indicating poorer gout control.
- Many patients did not undergo annual serum uric acid testing.
- Suboptimal management of gout and cardiovascular risk factors was observed.
Conclusions:
- Gout management is frequently suboptimal, with testing often limited to acute attacks.
- Annual serum uric acid level monitoring is recommended.
- Integrated management of modifiable cardiovascular risk factors is essential for gout patients.
Background And Context:
In New Zealand, the highest prevalence of gout is in Maori and Pacific people. Counties Manukau District Health Board (CMDHB) has the highest Maori and Pacific population of any New Zealand District Health Board. A CMDHB study found that a high proportion of patients with gout were also at increased risk of cardiovascular disease.
Assessment Of Problems:
The primary objective was to examine whether the control of gout had changed over time at one clinic. The secondary objective was to assess the management of cardiovascular risk factors in patients with gout at that clinic.
Results:
The mean serum uric acid level of patients with gout in the practice had risen in comparison with a similar audit carried out in March 2009. This indicates that the control of gout for patients at the practice has worsened over time. Many patients had not had an annual serum uric acid test.
Strategies For Improvement:
A repeat uric acid level was scheduled for all patients with gout in the practice, with follow-up appointments to be arranged if the result was abnormal.
Lessons:
Gout is often suboptimally managed. Serum uric acid levels may only be tested when a patient presents with an acute attack of gout. Consideration should be given to a minimum of annual serum uric acid levels. Appropriate management of modifiable cardiovascular risk factors in this particular cohort is important and should be a particular focus of care.
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