SAT0419 HAS THE INTRODUCTION OF A PRIMARY CARE GOUT GUIDELINE RESULTED IN SERUM URIC ACID (SUA) TARGETS BEING ACHIEVED?
Authors: Rashid Farid, Leanne Gray, Dean John, Daniel Holehouse, Lesley Ottewell
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Gout is the most common inflammatory arthritis thought to affect 2.4% of the UK population. A local primary care audit in 2012 suggested suboptimal gout management. In an attempt to improve gout management we introduced a local guideline which was supported by an increase in gout education to our local primary care physicians. <h3>Objectives:</h3> To assess the impact of a local primary care gout guideline (introduced in 2015) by comparing pre-guideline audit data (2012) to post guidelines audit data (2019). To identify if the introduction of this guideline translated into a reduction in secondary care referrals for advice on gout management. <h3>Methods:</h3> Retrospective analysis of primary care data covering all patients with active diagnosis of gout since 2015 in a large primary care medical group (list size of 30,000 patients). This data was then compared to the results of a previous audit carried out prior to introduction of guideline (2012). As well as assessing primary care data, we carried out a secondary care audit pre and post guideline introduction. <h3>Results:</h3> Out of a population list of 30,000 patients, 650 (2.1%) cases were coded as gout. 521 (80%) were male and 129(20%) were female. 429(66%) were on ULT. 407 (94.8%) were on Allopurinol. 21(4.8%) were on Febuxostat and only 1 patient on sulfinpyrazone. Of those on Allopurinol, 24 (5.9%) had no documented monitoring of sUA levels. Out of the remaining 383 (94.1%), 179 (46.7%) achieved target sUA of &lt;360, compared to 16.7% in the previous audit. 204 (53.3%) had not achieve the target SUA levels. 178 (46.4%) patients had had their sUA levels checked in the last year compared to 23.5% in the previous audit. 107 (28%) had SUA levels checked in last 3 years compared to 40% in the previous audit. SUA levels were not checked in the last 3 years in 98(25.6%) compared to 36.4% in the past. Of those on febuxostat, 14 (67%) achieved target sUA levels. 7 (33%) did not achieve target sUA levels. 10 (47%) patients had their sUA levels checked in the last year. 7(33%) had their sUA levels checked within the last 3 years and 4 (20%) had not had their sUA levels checked within the last 3 years. No patient was prescribed more than 300mg allopurinol daily by their primary care physician despite the recommended dose being up to 900mg daily. We found a 70% reduction in the number of referrals to secondary care for gout management over the same period of time. <h3>Conclusion:</h3> The introduction of a local primary care gout guideline and associated education appears to have improved the number of patients achieving target serum uric acid levels as well as leading to a reduction in secondary care referrals for gout. <h3>References</h3> [1] http://www.lancsmmg.nhs.uk/download/guidelines/Gout-Prescribing-Guidance-Version-1.2-FOR-WEBSITE.pdf [2] https://academic.oup.com/rheumatology/article/56/7/e1/3855179 <h3>Disclosure of Interests:</h3> None declared