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UK researchers have shown that nurse-led gout management, using a treat-to-target urate-lowering strategy, is efficacious and cost-effective compared with usual physicain care. The results are published in the recent Lancet edition.
Worldwide, gout management is suboptimal. In the UK only 40% of gout patients receive urate-lowering therapy, and fewer ever achieve a target serum urate (< 6mg/d) concentration.
Gout patients with a gout flare in the last 12 months were randomly assigned to receive either specially trained, nurse-led care or continue with GP-led usual care. The primary endpoint was the percentage of participants who achieved serum urate concentrations less than 360 μmol/L (6 mg/dL) at 2 years.
A total of 517 gout patients were enrolled, of whom 255 were assigned nurse-led care and 262 usual care. The results were staggeringly in favor of nurse-led care, especially with regard to:
- Uptake of and adherence to urate-lowering therapy (96% vs 56%, p = 0·0053 )
- Achieving target urate at 2 years (95% vs 30%, RR 3·18, 95% CI 2·42–4·18, p<0·0001).
- Fewer flares after 2 years (8% vs 24%; p <0·0001)
- The cost per QALY gained for the nurse-led intervention was £5066 at 2 years.
Community-based nurse-led care involving education and engagement of patients and a treat-to-target strategy for urate-lowering therapy achieved target serum urate concentrations and improved patient-centred outcomes in more than 90% of patients with gout. This study underscores the benefits of educating and engaging patients in gout management and reaffirm the importance of a treat-to-target urate-lowering treatment strategy to improve patient-centred outcomes.