C.Y.CHAN1, C.WANG1, M.K.LEE RICHARD1
Suboptimal gout control leads to frequent gouty flares and increase unplanned clinic visits. Our study aimed to examine outcomes of patients with frequent gout flares requiring urate lowering therapy (ULT) initiation in the APN-led clinic. We hypothesize that medication-adherent patients had lower serum uric acid (SUA) level and gout flare visits.
A pilot study was conducted in Woodlands Polyclinic over 1.5 years involving specific gout patient education and ULT initiation. Pre and post SUA levels, clinic visits for acute flares and ULT adherence were collected. Independent sample T-test was used to evaluate association between medication adherence, SUA levels and gout flare visits. Paired sample T-test was used to compare differences in number of gout flare visits pre and post study.
Twenty-five patients were followed up in the APN-led clinic. Majority were male (96%) with mean age of 53.2 years. Fifteen patients (60%) had 3 or more existing comorbidities. Patients who were ULT adherent had significantly lower SUA levels (448 ± 102.8 vs 594 ± 64.1, p=0.006). There was a statistically significant reduction in number of acute gout flare visits (3.24 ± 1.71 to 0.16 ± 0.47, p<0.001) and SUA levels (559 ± 84.4 to 496 ± 114.2, p=0.012) from baseline to 6-months post study initiation respectively.
The study showed that targeted gout education and ULT adherence lowered SUA levels in APN-led clinic. Overall, there was reduction in acute gout flare clinic visits. Increased emphasis on timely ULT dose escalation, adherence and gout trigger identification are suggested to optimize gout management.