Improved management of acute gout during hospitalization following introduction of a protocol

Aim:  To determine whether implementation of a protocol to manage in‐hospital acute gout has improved the care of patients by non‐rheumatologists. Method:  Two systematic case‐file reviews were performed to determine the management of acute gout in all episodes occurring in hospitalized patients bef...

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Bibliographic Details
Published in:International journal of rheumatic diseases 2012-12, Vol.15 (6), p.512-520
Main Authors: KAMALARAJ, Narainraj, GNANENTHIRAN, Sonali R., KATHIRGAMANATHAN, Theepan, HASSETT, Geraldine M., GIBSON, Kathryn A., McNEIL, H. Patrick
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
clinical guideline
Clinical Protocols
Clinical trials
Cross-Sectional Studies
Delayed Diagnosis
Drug Interactions
Drug Therapy, Combination
Female
gout
Gout - diagnosis
Gout - drug therapy
Gout Suppressants - adverse effects
Gout Suppressants - therapeutic use
Guideline Adherence
Hospitalization
Humans
Inappropriate Prescribing - prevention & control
Male
Middle Aged
New South Wales
Outcome and Process Assessment (Health Care)
outcomes research
Practice Guidelines as Topic
Predictive Value of Tests
Program Evaluation
Quality Improvement
Referral and Consultation
Rheumatism
Rheumatology
Tertiary Care Centers
Time Factors
Treatment Outcome
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Summary:Aim:  To determine whether implementation of a protocol to manage in‐hospital acute gout has improved the care of patients by non‐rheumatologists. Method:  Two systematic case‐file reviews were performed to determine the management of acute gout in all episodes occurring in hospitalized patients before (April 2005–December 2006) and after (November 2008–September 2009) introduction of a protocol for acute gout management in a tertiary referral hospital. The protocol targeted non‐rheumatologists with primary intentions to continue baseline anti‐gout medications on admission, prevent inappropriate prescriptions of colchicine, non‐steroidal anti‐inflammatory drugs (NSAIDs) and allopurinol in the hospital, encourage invitations for assistance by rheumatology, and promote combination therapy in cases of severe gout. Results:  Excluding patients under the primary care of a rheumatologist, 118 cases of acute gout occurring during hospitalization were reviewed before and 89 cases after introduction of the gout protocol. Post‐protocol, there was a significant increase in continuation of baseline allopurinol (P = 0.01), significantly less inappropriate prescriptions of colchicine (P 
ISSN:1756-1841
1756-185X
DOI:10.1111/j.1756-185X.2011.01642.x