%0 Journal Article %T Incorporating gout guideline advice into urate reports is associated with reduced hospital admissions: results of an observational study. %A Riches PL %A Downie L %A Thomson C %J Rheumatology (Oxford) %V 0 %N 0 %D Sep 2021 16 %M 34528071 %F 7.046 %R 10.1093/rheumatology/keab689 %X OBJECTIVE: To evaluate the impact of incorporating treatment guidance into reporting of urate test results.
METHODS: Urate targets for clinically confirmed gout were added to urate results above 0.36 mmol/l requested after September 2014 within NHS Lothian. Scotland-wide data on urate-lowering therapy prescriptions and hospital admissions with gout were analysed between 2009 and 2020. Local data on urate tests were analysed between 2014 and 2015.
RESULTS: Admissions with a primary diagnosis of gout in Lothian reduced modestly following the intervention from 111/year in 2010-2014-104/year in 2015-2019, a non-significant difference (p= 0.32). In contrast there was a significant increase in admissions to remaining NHS Scotland health boards (556/year vs 606/year, p< 0.01). For a secondary diagnosis of gout the number of admissions in NHS Lothian reduced significantly (58/year vs 39/year, p< 0.01) contrasting with a significant increase in remaining Scottish health boards (220/year vs 290/year, p< 0.01). The relative rate of admissions to NHS Lothian compared with remaining Scottish boards using a 2009 baseline were significantly reduced for both primary diagnosis of gout (1.06 vs 1.25, p< 0.001) and secondary diagnoses of gout (0.64 compared with 1.4, p< 0.001) after the intervention; however, there was no difference before the intervention. A relative increase in the prescription rates of allopurinol 300 mg tablets and febuxostat 120 mg tablets may have contributed to the improved outcomes seen.
CONCLUSIONS: Incorporation of clinical guideline advice into routine reporting of urate results was associated with reduced rates of admission with gout in NHS Lothian, in comparison to other Scottish health boards.