Improving Gout Care in a Canadian Academic Medical Centre Through a Multidisciplinary Nurse-led Protocol.

Abstract

Following Health Canada's Knowledge Translation framework, to report the results of a clinical audit from 2012 to 2015 followed by a multidisciplinary nurse-led gout care protocol with a treat-to-target (T2T) strategy implemented in April 2018. Clinical audit with chart reviewing was completed for adults with gout and urate lowering therapy (ULT) indication. A nurse-led treatment algorithm using allopurinol was then developed. Titration of ULT by a nurse every four weeks was done until serum uric acid (sUA) target. Adults with gout and ULT indication were retrospectively recruited through billing agency until December 2020. Main outcome was sUA target achievement at six months. Of 50 patients identified in the audit, 31% reached serum uric acid (sUA) target at six months and 16% were lost to follow-up. A 74-patient post-protocol implementation cohort was recruited: 43 in the protocol group and 31 under usual care. Most prevalent ULT indication was two or more gouty attacks per year (n=52) at 70%. Target sUA was reached in 65% (n=28) in the protocol group at six months compared to 19% (n=6) in the usual care group (p<0.001). Failing to titrate medication in the usual care group was the leading cause for non-achievement of sUA target at six months. Lost to follow-up was seen in 5% of patients: all in the usual care group. A multidisciplinary nurse-led protocol with a T2T strategy implemented after a clinical audit significantly improved gout care at the CHUS. Such protocol could be replicated elsewhere in Canada.