期刊
JOURNAL OF PRIMARY HEALTH CARE
卷 1, 期 4, 页码 315-318出版社
CSIRO PUBLISHING
DOI: 10.1071/HC09315
关键词
Gout; uric acid; clinical audit; benchmarking; family practice
AIM: To establish a benchmark for gout control using the proportion of patients with serum uric acid (SUA)<0.36 mmol/L, assess patients' understanding of their preventive medication and trial a mail and phone intervention to improve gout control. METHODS: Patients clinically diagnosed with gout and baseline SUAs were identified in two South Auckland practices. A mail and phone intervention was introduced aimed at improving the control of gout. Intervention #1 took place in one practice over three months. Intervention #2 occurred in the other practice four to 16 months following baseline. RESULTS: No significant change in SUA from intervention #1 after three months. The second intervention by mail and phone resulted in improvement in SUA levels with a greater proportion of those with SUA <0.36 mmol/L and the difference in means statistically significant (p=0.039 two-tailed paired Hest). Benchmarking for usual care was established at 38-43% SUA <0.36 level. It was possible to increase from 38% to 50%. Issues relating to gout identified included lack of understanding of the need for long-term allopurinol and diagnosis and management for patients for whom English is not their first language. STRATEGIES FOR IMPROVEMENT: 1. Community workers who speak Pacific languages may assist GPs in communicating to non-English speaking patients. 2. Alternative diagnoses should be considered in symptomatic patients with prolonged normouricaemia. 3. GPs should gradually introduce allopurinol after acute gout attacks, emphasising importance of prophylaxis. 4. A campaign to inform patients about benefits of allopurinol should be considered. 5. A simple one keystroke audit is needed for gout audit and benchmarking. 6. GP guidelines for gout diagnosis and management should be available.
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