Rheumatic Diseases Unit, Western General Hospital, NHS Lothian, Edinburgh.
Public Health Scotland, Meridian Court, Glasgow.
Rheumatology (Oxford). 2022 May 5;61(5):1885-1891. doi: 10.1093/rheumatology/keab689.
To evaluate the impact of incorporating treatment guidance into reporting of urate test results.
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.
Admissions with a primary diagnosis of gout in Lothian reduced modestly following the intervention from 111/year in 2010-2014 to 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.
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 with other Scottish health boards.
评估将治疗指南纳入尿酸检测结果报告对其产生的影响。
在 2014 年 9 月之后，苏格兰 NHS Lothian 对尿酸值高于 0.36mmol/L 的尿酸检测结果，在报告中加入了临床确诊痛风的尿酸目标值。分析了 2009 年至 2020 年期间降尿酸治疗处方和痛风住院治疗的苏格兰范围内的数据，分析了 2014 年至 2015 年期间当地尿酸检测的数据。
在干预措施实施后，洛锡安区痛风的主要诊断入院人数略有减少，从 2010 年至 2014 年的每年 111 人减少到 2015 年至 2019 年的每年 104 人，差异无统计学意义（P=0.32）。相比之下，NHS 苏格兰其他健康委员会的入院人数显著增加（每年 556 人比每年 606 人，P<0.01）。作为痛风的次要诊断，NHS Lothian 的入院人数显著减少（每年 58 人比每年 39 人，P<0.01），而苏格兰其他健康委员会的入院人数显著增加（每年 220 人比每年 290 人，P<0.01）。与 2009 年基线相比，使用 2015 年的尿酸检测结果，NHS Lothian 与苏格兰其他地区相比，痛风的主要诊断（1.06 比 1.25，P<0.001）和次要诊断（0.64 比 1.4，P<0.001）的入院相对比率均显著降低，但干预前无差异。所有嘌呤醇 300mg 片和非布索坦 120mg 片的处方率相对增加，可能促成了所观察到的结果改善。
将临床指南建议纳入尿酸检测结果的常规报告与 NHS Lothian 痛风入院率的降低有关，与苏格兰其他健康委员会相比。
