The PREVENT Study: Preventing hospital admissions attributable to gout

Research question Can we improve care for patients admitted to hospital with gout, and reduce hospital re-admissions, using a treat-to-target strategy integrated between primary and secondary care? Background Gout is the most common form of inflammatory arthritis, with a rising incidence and prevalence worldwide.

My previous research has demonstrated that hospital admissions due to acute gout have increased by 58% in England since 2006, accounting for 350,000 NHS bed-days, at a cost of up to £5,662 per admission. Gout is inherently curable, yet poorly managed, and many of these admissions are avoidable. We urgently need a strategy to reduce hospitalisations and improve care for patients admitted with gout.

Aims and objectives My research plan has 3 phases: To describe the current epidemiology of admitted gout care, including identification of individual and structural predictors of hospitalisation; To develop a gout care pathway at the primary/secondary care interface that can be implemented during an acute admission, with the aim of improving care and reducing future hospitalisations; To evaluate the implementation of this strategy in patients admitted with gout at three local hospitals over a 12-month period.

Methods (timelines for delivery) Phase 1 (0-9 months): Using the Royal College of General Practitioners Research and Surveillance Centre and Hospital Episode Statistics datasets, I will analyse hospital admissions due to gout in England between 2004 and 2020. I will examine the use of urate-lowering therapy and treat-to-target optimisation.

Statistical modelling will be employed to identify individual and structural characteristics predicting hospitalisation and sub-optimal care.

Phase 2 (9-14 months): I will process map the admitted patient journey in a retrospective sample of patients hospitalised for gout.

I will work with stakeholders to identify barriers and facilitators of optimal admitted gout care, and adapt an evidence-based intervention for implementation during acute admissions.

This will incorporate treat-to-target optimisation of urate-lowering medications and self-management approaches, embedded at the primary/secondary care interface.

Phase 3 (14-36 months): I will prospectively evaluate the implementation of the intervention I have developed in Phase 2 in patients admitted with acute gout exacerbations at three local hospitals over a 12-month period.

I will adopt a hybrid type 3 effectiveness-implementation study design, with outcome measures including: re-admission rates, intervention uptake and acceptability, and health resource utilisation.

Anticipated impact and dissemination My research proposal will inform a UK-wide clinical trial to improve admitted gout care and reduce hospitalisations.

The impact of my research for patients will be reduced morbidity, with fewer painful gout attacks and reduced accumulation of disability.

The impact for the NHS will include reduced costs of unplanned admissions, and improved integration of care for clinicians managing this chronic disease.

I will disseminate my findings through publications, presentations, public engagement events, and implementation recommendations.