Abstract Background/Aims Despite being the most prevalent inflammatory arthritis in the UK, gout is often undertreated in primary care. NICE guidelines recommend titrating allopurinol to maintain serum urate levels below 360 µmol/L, following a treat-to-target approach with annual monitoring. A full-cycle audit was conducted between August 2024 and October 2025 to assess whether this standard of treatment is met in a GP practice in Oxford. Methods An EMIS search was conducted in August 2024 to identify patients with a diagnosis of gout and an active prescription for allopurinol. The date and result of their last serum urate measurement was also obtained. The results were re-audited in October 2025. Results In the first cycle, 68 out of the 141 patients had received a urate level within the past 12 months. Of this group, 40 patients (58.8%) either had urate levels less than 360 µmol/L or had had their allopurinol dose increased as per the treat-to-target guidance. The remaining 28 patients had no changes made to their medication dose and no follow-up appointment to further discuss their urate levels. 67 of the 141 patients had not received a serum urate within the last 12 months, with 37% having had a serum urate measurement over 360 µmol/L when last tested, with no medication changes noted. 6 patients did not have a serum urate level ever noted on EMIS. Following clinician education, the re-audit in October 2025 showed that a similar number of patients had received a yearly urate measurement (65 out of 142). However, 57 (87.7%) were being managed in accordance with NICE guidelines, representing an almost 30% increase from the initial audit. Of the 77 patients who had not received a yearly urate measurement, 23.4% had urate levels above 360 micromol/litre. There was a six-fold decrease in the patients without a serum urate level ever noted on EMIS. During data extraction, it was noted that the upper limit of the normal bounds for serum urate levels differed between EMIS and NICE recommended ranges. Conclusion Following clinician education regarding the current NICE treat-to-target guidelines for the management of gout, there was an 11.4% increase in the number of patients who were being managed accordingly. When patients had received a urate measurement within the past year, 87.7% were now being managed appropriately, compared to 58.8% in the first cycle. There was also a significant decrease in the number of patients who did not have a urate level noted on EMIS. It is clear that clinical education can improve gout management in primary care; however, further action to increase the number of patients who receive annual monitoring and to address the discrepancies between reference ranges for gout patients is needed to continue to improve patient care. Disclosure V.C. Black: None.
Verity C Black (Wed,) studied this question.