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Gout in primary care: Can we improve patient outcomes?
Jacqueline Callear1, Georgina Blakey1, Alexandra Callear1
1Sloan Medical Practice, Sheffield.
Insights
Simple interventions significantly improved gout management in primary care, enhancing medication compliance and reducing flares and consultations. Patient education and monitoring were key to sustained positive outcomes.
Area of Science:
- Rheumatology
- Primary Care Medicine
- Health Services Research
Background:
- Gout is a prevalent inflammatory arthropathy in the UK, often managed in primary care.
- Suboptimal gout management is common due to a lack of incentivised protocols.
- Gout is a significant indicator for cardiovascular disease and comorbidities.
Purpose of the Study:
- To investigate the impact of improvement cycles on gout management in primary care.
- To enhance patient education, uric acid monitoring, and medication compliance.
- To assess the sustainability of improved disease control and patient outcomes.
Main Methods:
- Retrospective analysis of 115 gout patients in a primary care setting (Jan 2014-Dec 2014).
- Implementation of improvement cycles focusing on patient education and adherence support.
- Plan-Do-Study-Act (PDSA) cycles to evaluate sustainability of interventions.
Main Results:
- Uric acid levels decreased from 0.37 to 0.3 (p=0.14).
- Gout flares reduced by 20%, and GP consultations by 77%.
- Medication compliance improved from 63% to 91% (p=0.0001), sustained at 100% with a calendar intervention.
Conclusions:
- Simple interventions, including patient education and adherence aids, can sustainably improve gout management.
- Enhanced monitoring and support are crucial for long-term patient outcomes in primary care.
- Addressing suboptimal management can lead to significant reductions in flares and healthcare utilization.
Abstract:
In the United Kingdom, gout represents one of the most common inflammatory arthropathies predominantly managed in the primary care setting. Gout is a red flag indicator for cardiovascular disease and comorbidity. Despite this, there are no incentivised treatment protocols and suboptimal management in the primary care setting is common. A computer based retrospective search at a large inner city GP practice between January 2014-December 2014 inclusive, identified 115 patients with gout. Baseline measurements revealed multiple gout related consultations, poor medication compliance, high uric acid levels and deficiencies in uric acid monitoring. A series of improvement cycles were conducted. A telephone questionnaire conducted in January 2015, identified that patient education was suboptimal. The following improvement cycles aimed to educate patients, improve uric acid monitoring and support medication compliance. It was ultimately hoped that these measures would reduce gout flares and GP practice attendance. The improvement cycles contributed towards reduction in uric acid levels from 0.37 to 0.3 (p=0.14), 20% reduction in patients experiencing one or more gout flares and 77% reduction in GP related consultations between March 2015-March 2016 compared to baseline. The proportion of patients fully compliant with taking their urate lowering therapies improved from 63% to 91% (p=0.0001). A follow up series of PDSA cycles were performed between July-December 2016. The purpose of these cycles was to assess the sustainability of the improved medication compliance demonstrated by the improvement cycles. Three months following the completion of the improvement cycles, full medication compliance dropped from 91% to 70% (p=0.0001). The introduction of a paper calendar saw sustained and maintained improvement in medication compliance to 100% (p=0.0001) at the end of the study period. The improvement and PDSA cycles have demonstrated that simple interventions can be a sustainable way of improving disease control and patient outcomes.
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