Data

Data is crucial to establish a baseline (what is the extent of the issue within your practice) as well as for monitoring and tracking as your team progresses.

Step 1: Before your team starts, identify who to prioritise

The aim of your project is to achieve equitable outcomes so collect whole of practice data for whānau Māori and Pacific peoples. Use the following criteria:

Diagnosed with gout.
Currently or previously prescribed uric acid lowering medicine.
Age range – because gout affects Māori and Pacific peoples at a much younger age than non-Māori and non-Pacific people, consider starting the age range at 20 years.
Time range – 5 years is a useful starting point; however, you could opt for a shorter period once you see the data.

From the Whanganui GOUT STOP programme: It was suggested at the start that all practices did an audit of all whānau Māori and Pacific peoples with gout over the last 2 years. Practices then cleaned their data removing any coding errors to ensure a baseline for the beginning of the programme. Practices that went through the audit and data cleaning process were more motivated and had better equitable outcomes than other practices in the GOUT STOP programme.

From the Whanganui GOUT STOP programme evaluation report: Plan which indicators are meaningful for your team to enable feedback within a learning and improvement culture.

Refining data for your project

Once you have your whole of practice data you can then decide on the scope and focus of your project. Partly this will depend on:

the resources you have to commit to the project
what you notice from the whole of practice data
whether you want to use this project in combination with other preventative health activities, eg, Cardiovascular Disease Risk Assessment (CVDRA) and Diabetes Annual Reviews (DAR).

Fromthe ProCare Gout Collaborative: One practice decided to use data for all whānau Māori and Pacific peoples with gout because all GPs and nurses were available for the project.

From the ProCare Gout Collaborative: Another practice decided to focus on Māori and Pacific men 35– 45 years of age because the practice had the largest numbers in this age range.

From the Whanganui GOUT STOP programme: CVDRA was included in the advanced form for all whānau Māori and Pacific peoples with gout. When blood tests were ordered, results were requested for CVD as well to ensure follow-up as required. The made it easier for the practice team and the person getting the blood tests.

Prioritising whānau Māori and Pacific peoples with gout doesn’t stop other people with gout, who are not in the priority group, receiving appropriate treatment for their gout when they attend your practice.

Different ways you can collect data

You can use query builds through your Practice Management System or use Dr Info. Otherwise, your PHO may be able to assist you.

Another option is to use the free EPIC data dashboard developed by He Ako Hiringa:

EPiC data dashboard

Developed by He Ako Hiringa

Evaluating Prescribing to Inform Care. Explore our data themes to learn more about medicine use in Aotearoa and how you can help address national problems of prescribing practice and improve medicine access equity.

Link to page:

EPiC Dashboard

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Results from the EPIC dashboard won’t give you patient NHI numbers so further work will need to be done to identify the actual people with gout. Check with your PHO to see if they’re able to provide patient specific lists.

<aside> 💡 You can also use the EPIC dashboard to reflect on your team’s prescribing data for gout.

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EPiC Reflect Gout

He Ako Hiringa

Explore your prescribing further with EPiC Reflect Gout. This activity helps you to delve into your EPiC data, contemplate your prescribing, reflect on your current practice, and set goals and actions. Available as an editable PDF document, EPiC Reflect helps you to incorporate your learning into your everyday practice.

Link to page:

EPiC Reflect - Gout

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Step 2: During the project – using data for ongoing monitoring and tracking

Before you start your project, your team needs to agree on how often data is required for feedback, monitoring and tracking purposes. Consider how easy it’s going to be to get data reports every month (or weekly or fortnightly as decided by you).

Regular feedback to monitor and track progress will support quality improvement strategies and enable your team to make changes to ensure equitable health outcomes.

These feedback loops enable your team to share data within the team and identify what’s working well and what needs to be changed or adjusted. Regular discussion about data also motivates the team to persist in the face of the challenges of day-to-day operations.

At this step, data required for monitoring and tracking include numbers of whānau Māori and Pacific peoples with gout who have:

Been contacted.
Had conversations about gout with primary care team.
Had uric acid levels checked.
Declined taking uric acid medicines at this time.
Been prescribed uric acid medicine.
Had uric acid medicines up titrated based on uric acid levels.
Achieved treatment goal.
Not completed the project either because they never completed titration or chose to leave the project. Interviews with people in this group are critical to understanding and addressing ongoing barriers to the success of the project – especially once it becomes business as usual. People in this group should be contacted at regular intervals in case they change their minds.

Step 3: Ensuring maintenance of supply once treatment goal is achieved – using data for ongoing monitoring and tracking

At this step, data required for monitoring and tracking include numbers of whānau Māori and Pacific peoples with gout who have:

Been followed up for 3–6 months after achieving their treatment goal (checking on attacks and ensuring supply).
Been followed up for 12 months after achieving their treatment goal (arranging blood test, checking on attacks and ensuring continuity of supply of medicines).