Strategy to improve the request of uric acid in primary care: Preliminary results and evaluation through process and outcome appropriateness indicators

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• 作者：Maria Salinas^a ; ^b ; ^{salinas_mar@gva.es" class="auth_mail} ; Maite Ló ; pez-Garrigó ; s^a ; Alberto Asencio^c ; Enrique Batlle^d ; Mauricio Minguez^d ; Javier Lugo^a ; Elí ; as Salinas^e ; Carlos Leiva-Salinas^f
• 关键词：Uric acid ; Gout ; Hyperuricemia ; Laboratory management ; Test request ; Appropriateness ; Patient safety
• 刊名：Clinical Biochemistry
• 出版年：April, 2014
• 年：2014
• 卷：47
• 期：6
• 页码：467-470
• 全文大小：407 K

文摘

Introduction

Alerted by the high rates of request of serum uric acid (UA) in primary care patients, we aimed to design a strategy to improve such an indicator, and to monitor such an intervention through process and outcome appropriateness indicators.

Methods

To design the strategy, several meetings were held between the Laboratory, Rheumatology and Primary Care. The intervention consisted of discharging UA from two laboratory profiles (鈥淗ealth Check鈥?and 鈥淩heumatology鈥?, making it only possible to request the test in an individualized manner.

To assess the intervention effectiveness, the ratio of UA/glucose requests, the quantity of allopurinol prescription and the resulting economic savings were calculated and compared for pre- and post-intervention 12 month periods.

Results

There was a 70% decrease in the number of UA requests in the post-intervention period, as compared to the pre-intervention interval. The ratio of UA/glucose requests experienced a significant commensurate drop in the post-intervention period (p < 0.01). There was a significant reduction in the prescription of allopurinol (p < 0.01). From an economic perspective, the strategy resulted in a savings of 8190 鈧?

Conclusion

The strategy resulted in a dramatic drop in the number of UA requests and in the prescription of allopurinol. This highlights a likely existence of prior unnecessary treatment of patients with hyperuricemia in the absence of clinical symptoms.