Improving Gout Care in a Canadian Academic Medical Center Through a Multidisciplinary Nurse-Led Protocol.

Abstract

Objective: Following Health Canada's knowledge translation framework, we 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.

Methods: A clinical audit with chart reviewing was completed for adults with gout and urate-lowering therapy (ULT) indication at the Centre Hospitalier Universitaire de Sherbrooke. A nurse-led treatment algorithm using allopurinol was then developed. Titration of ULT by a nurse every 4 weeks was done until serum uric acid (SUA) target. In the postprotocol implementation, adults with gout and ULT indication were retrospectively recruited through a billing agency until December 2020. The main outcome was SUA target achievement at 6 months.

Results: Of 50 patients identified in the audit, 31% reached SUA target at 6 months and 16% were lost to follow-up. A 74-patient postprotocol implementation cohort was recruited, with 43 in the protocol group and 31 under usual care. Most prevalent ULT indication was ≥ 2 gout attacks per year (n = 52) at 70%. Target SUA was reached in 65% (n = 28) in the protocol group at 6 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 nonachievement of SUA target at 6 months. Five percent of patients were lost to follow-up, all in the usual care group.

Conclusion: A multidisciplinary, nurse-led protocol with a T2T strategy implemented after a clinical audit significantly improved gout care. Such protocol could be replicated elsewhere in Canada.