OBJECTIVE Following Health Canada's knowledge translation framework, we report the results of a clinical audit from 2012 to 2015 followed by a multidisciplinary, nurse-led gout care protocol with a treat-to-target (T2T) strategy implemented in April 2018. METHODS A clinical audit with chart reviewing was completed for adults with gout and urate-lowering therapy (ULT) indication at the Centre Hospitalier Universitaire de Sherbrooke. A nurse-led treatment algorithm using allopurinol was then developed. Titration of ULT by a nurse every 4 weeks was done until serum uric acid (SUA) target. In the postprotocol implementation, adults with gout and ULT indication were retrospectively recruited through a billing agency until December 2020. The main outcome was SUA target achievement at 6 months. RESULTS Of 50 patients identified in the audit, 31% reached SUA target at 6 months and 16% were lost to follow-up. A 74-patient postprotocol implementation cohort was recruited, with 43 in the protocol group and 31 under usual care. Most prevalent ULT indication was ≥ 2 gout attacks per year (n = 52) at 70%. Target SUA was reached in 65% (n = 28) in the protocol group at 6 months compared to 19% (n = 6) in the usual care group (P < 0.001). Failing to titrate medication in the usual care group was the leading cause for nonachievement of SUA target at 6 months. Five percent of patients were lost to follow-up, all in the usual care group. CONCLUSION A multidisciplinary, nurse-led protocol with a T2T strategy implemented after a clinical audit significantly improved gout care. Such protocol could be replicated elsewhere in Canada.

中文翻译：

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通过多学科护士主导的方案改善加拿大学术医疗中心的痛风护理。


目标 遵循加拿大卫生部的知识转化框架，我们报告了 2012 年至 2015 年的临床审计结果，然后是多学科、护士主导的痛风护理方案，并于 2018 年 4 月实施了治疗到目标 （T2T） 策略。方法 在 Centre Hospitalier Universitaire de Sherbrooke 完成了对患有痛风和降尿酸治疗 （ULT） 指征的成人的临床审计和图表审查。然后开发了一种使用别嘌呤醇的护士主导的治疗算法。护士每 4 周调整一次 ULT，直至达到血清尿酸 （SUA） 目标。在方案后实施中，通过计费机构回顾性招募患有痛风和 ULT 指征的成年人，直到 2020 年 12 月。主要结局是 6 个月时 SUA 目标实现。结果 在审计中确定的 50 名患者中，31% 在 6 个月时达到 SUA 目标，16% 失访。招募了一个 74 名患者的方案后实施队列，其中 43 名在方案组中，31 名接受常规护理。最普遍的 ULT 指征是每年 2 次痛风发作 （n = 52），占 70%，≥ 2 次。方案组在 6 个月时达到目标 SUA 为 65% （n = 28），而常规护理组为 19% （n = 6） （P < 0.001）。常规护理组未能调整药物剂量是 6 个月时未达到 SUA 目标的主要原因。5% 的患者失访，均在常规护理组中。结论 在临床审计后实施的多学科、护士主导的方案和 T2T 策略显着改善了痛风护理。这样的协议可以在加拿大的其他地方复制。