A prospective study of acute inpatient gout diagnoses and management in a tertiary hospital: the determinants and outcome of a rheumatology consultation

Teichtahl, Andrew; Clemens, Laurence; Nikpour, Mandana; Romas, E.

doi:10.1111/imj.12541

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…Studies of hospitalization in gout are few (120 citations resulted from a MEDLINE search on 16 December 2015 using the keywords gout and hospitalization), which demonstrates that this area is understudied. Studies have focused on seasonal variation [ 11 ], quality of care or specific treatment patterns [ 12 – 15 ], time trends [ 16 ], economic burden [ 16 , 17 ], or comparison of charges in gout versus non-gout population [ 5 , 17 ]. Several knowledge gaps exist.…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, none of the previous studies examined predictors of inpatient utilization or disposition after hospitalization for gout. Most studies except one study [ 16 ] used non-representative samples from tertiary care centers [ 12 – 15 ] or combined all crystalline diseases [ 12 , 15 , 17 ], which limited the generalizability of findings to general populations with gout.…”

Section: Introductionmentioning

confidence: 99%

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Gout-related inpatient utilization: a study of predictors of outcomes and time trends

Singh

2016

Arthritis Res Ther

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BackgroundTo assess inpatient healthcare burden of gout in the USA after an Emergency Department (ED) visit and the predictors of gout-related hospitalizations.MethodWe used the 2009, 2010 and 2012 US National ED Sample (NEDS) data to examine the time trends in inpatient visits with gout as the primary diagnosis. We used the 2012 NEDS data to assess multivariable-adjusted predictors of length of hospital stay, discharge to home (versus other) and total charges for gout-related inpatient visits.ResultsOf the 205,152 ED visits for gout as the primary diagnosis in 2012, 7.7 % resulted in hospitalization. In 2009, 2010 and 2012, 63 %, 63 % and 64.5 % of hospitalized patients were discharged home; respective durations of hospital stay were 4.15, 4.00 and 3.86 days. Older age 50 to <65 years (ref <50), renal failure, heart failure, osteoarthritis and diabetes were associated with a longer hospital stay and self-pay/uninsured status, hospital location in the Midwest or Western USA with a shorter hospital stay for gout. Similar factors were associated with total charges for gout-related admissions. Older age (65 to <80 and ≥80, relative to <50 years), diabetes, self-pay/no charge insurance status, metropolitan area residence, and a longer length of hospital stay were associated with lower odds of discharge to home; and self-pay/no charge (uninsured) status was associated with higher odds of discharge to home, compared to Medicare coverage.ConclusionsUsing a national sample, we noted declining duration of hospital stay and identified factors associated with the length of hospital stay, discharge to home and charges for gout hospitalization following an ED visit. Future studies should examine whether better management of comorbidities in patients with gout can further reduce utilization and cost of gout-related hospitalizations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gout-related inpatient utilization: a study of predictors of outcomes and time trends

Singh

2016

Arthritis Res Ther

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“…The proportion of admissions with rheumatology input varied widely between studies, from 17% to 76%, averaging 40% across all studies. Rheumatology input was consistently associated with more intra-articular joint aspirations and/or steroid injections [ 26–31 ]. Those receiving rheumatology input were more likely to have had SU levels measured [ 28 , 30 , 31 ] and more likely to have received outpatient rheumatology follow-up [ 26–28 ], relative to patients without rheumatology input.…”

Section: Resultsmentioning

confidence: 99%

“…Rheumatology input was consistently associated with more intra-articular joint aspirations and/or steroid injections [ 26–31 ]. Those receiving rheumatology input were more likely to have had SU levels measured [ 28 , 30 , 31 ] and more likely to have received outpatient rheumatology follow-up [ 26–28 ], relative to patients without rheumatology input. Four studies reported significant associations between rheumatology consultation and increased utilization of ULT [ 25 , 27 , 29 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

Improving outcomes for patients hospitalized with gout: a systematic review

et al. 2021

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Objectives Hospital admissions for gout flares have increased dramatically in recent years, despite widely available, effective medications for the treatment and prevention of flares. We conducted a systematic review to evaluate the effectiveness and implementation of interventions in patients hospitalised for gout flares. Methods A search was conducted in MEDLINE, Embase and the Cochrane library, from database inception to 8 April 2021, using the terms gout and hospital and their synonyms. Studies were included if they evaluated the effectiveness and/or implementation of interventions during hospital admissions or emergency department attendances for gout flares. Risk of bias assessments were performed for included studies. Results Nineteen articles were included. Most studies were small, retrospective analyses performed in single centres, with concerns for bias. Eleven studies (including five randomised control trials) reported improved patient outcomes following pharmacological interventions with known efficacy in gout, including allopurinol, prednisolone, non-steroidal anti-inflammatory drugs and anakinra. Eight studies reported improved outcomes associated with non-pharmacological interventions: inpatient rheumatology consultation and a hospital gout management protocol. No studies to date have prospectively evaluated strategies designed to prevent re-admissions in patients hospitalised for gout flares. Conclusion There is an urgent need for high quality, prospective studies of strategies to improve uptake of urate-lowering therapies in hospitalised patients, incorporating prophylaxis against flares and treat-to-target optimisation of serum urate levels. Such studies are essential if the epidemic of hospital admissions from this treatable condition is to be countered.

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“…Several studies have shown the majority of hospital admissions are preventable (10); in that audits have demonstrated that patients admitted with gout commonly have elevated uric acid, and are not on appropriate urate lowering therapy (18). It has also been shown that inpatient care of people with gout in tertiary settings does not meet international guidelines (10) (19), and the majority of people followed up in specialised gout outpatient clinics do not meet therapeutic targets (10,16). Given the health care costs in Australia are rising at an alarming rate, gout appears to be a condition in which there is an opportunity to impact admission rates through optimising therapy.…”

Section: Discussionmentioning

confidence: 99%

Healthcare utilisation after discharge in patients admitted with gout in Western Australia

Kelty

Robinson²,

Hill

et al. 2021

Preprint

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Objectives Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable. Understanding the drivers of health care costs in patients with gout will allow more targeted intervention. The objective was to examine factors associated with high health service utilisation and costs in patients admitted to hospital with gout. Methods Hospital and emergency department data was obtained for patients who had been admitted to hospital with a diagnosis of gout for the first time between 2002 and 2009. The total number, cost and potentially preventable events for the follow-up period was calculated for up to five years post the initial gout hospitalisation. The association between patient characteristics with health service utilisation and health care costs was examined using generalised linear models. Results The cohort included 4,379 individuals, that had 22,222 ED attendances (median cost: $1,826 per patient, IQR: $433 - $4,414), and 58,920 hospital admissions (median cost: $25,009 per patient, IQR: $6,844 - $60,535). Gout was not a primary driver of ED attendances or hospitalisations. A history of smoking and comorbidities including cardiovascular disease, diabetes and mental health disorders were associated with an increase health service utilisation and costs. Conclusion The presence of comorbidities play an important role the risk of health service utilization in people with gout and represents an opportunity to both improve the health-related outcomes for these patients and reduce re-presentations and associated health care costs for the health care system.

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A prospective study of acute inpatient gout diagnoses and management in a tertiary hospital: the determinants and outcome of a rheumatology consultation

Cited by 6 publications

References 12 publications

Gout-related inpatient utilization: a study of predictors of outcomes and time trends

Gout-related inpatient utilization: a study of predictors of outcomes and time trends

Improving outcomes for patients hospitalized with gout: a systematic review

Healthcare utilisation after discharge in patients admitted with gout in Western Australia

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