POS0516 PERFORMANCE OF NURSE-LED GOUT CARE IN A PRIVATE HEALTHCARE SYSTEM. A RANDOMISED CONTROLLED TRIAL

Background

Nurse-led gout care has been studied mainly in managed healthcare systems [1].

Objectives

To investigate the effectiveness of a structured nurse-led gout programme in a private healthcare system.

Methods

A randomised single-blinded controlled trial with two study arms was performed. The inclusion criteria were the fulfilment of the 2015 ACR/EULAR gout classification criteria(2) and the indication for urate-lowering therapy (ULT). The inclusion period lasted 2 years and the intervention period 6 months. Physician FU visits took place at 6 and 12 months from baseline (BL). The achievement rate of the target serum acid level (SUA, ≤ 360 µmol/l) at the 6-month-FU served as the primary endpoint. In the intervention group, during the first six months after inclusion, a structured treat-to-target (T2T)-programme led by trained nurses was performed. In both groups, the patients were followed by their treating physicians without specific recommendations. We performed descriptive statistics. Categorical variables were reported as frequencies and compared using Fisher's exact test. Continuous variables were compared using Student's t-test or the Mann-Whitney U test in case of non-normal distribution.

Results

A total of 46 patients were included, of which 19 were randomised to the intervention group and 27 to the control group. Dropouts occurred in 6 patients in the intervention group and 3 in the control group. The median age was 69 years, and a pronounced male overrepresentation was found. 38% of the patients in the intervention group vs 53% in the control group were obese. Alcohol consumption was frequent in both groups (63% vs 59% of the patients). At BL, most patients were under an anti-inflammatory treatment (colchicine, steroids, NSAIDs). ULT was similar in both groups with a low median dosage of Allopurinol (250 mg/day at the 12 m FU). BL characteristics and outcomes are presented in Table 1.

Conclusion

There was no significant advantage over the standard of care regarding SUA reduction. However, the intervention patients showed twice as often impaired kidney function (grade 3-5) and tophaceous gout. Nevertheless, these patients reduced SUA levels better after 6 months (36% vs 26% reduction) and 64% of them achieved the SUA target after 12 months (vs 47% in the control group).

References

[1]Doherty, M.; Jenkins, W.; Richardson, H.; Sarmanova, A.; Abhishek, A.; Zhang, W. Efficacy and Cost-Effectiveness of Nurse-Led Care Involving Education and Engagement of Patients and a Treat-to-Target Urate-Lowering Strategy versus Usual Care for Gout: A Randomised Controlled Trial. The Lancet 2018, 392 (10156), 1403–1412. [2]Neogi, T.; Jansen, T. L. T. A.; Dalbeth, N; Nuki, G.; Ogdie, A.; Taylor, W. J. 2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Annals of the Rheumatic Diseases 2015, 74 (10), 1789–1798.

Acknowledgements:

NIL.

Disclosure of Interests

None Declared.