Quality of care for gout in the US needs improvement

Abstract

Objective. To examine evidence-based quality indicators (QIs) in US veterans with gout diagnosis, and to examine the effect of demographics, heath care utilization/access, comorbid conditions, or physican characteristics as predictors of quality of gout care. Methods. Using the Minneapolis Veterans Affairs electronic medical record system, we identified a cohort of veterans receiving medication to treat gout between January 1, 1999 and December 31, 2003, and evaluated 3 recently published evidence-based QIs for gout management: QI 1 ‫؍‬ allopurinol dose <300 mg in gout patients with renal insufficiency, QI 2 ‫؍‬ uric acid check within 6 months of starting a new allopurinol prescription, and QI 3 ‫؍‬ complete blood count and creatine kinase check every 6 months for gout patients receiving prolonged colchicine therapy. We calculated the proportion of patients whose therapy adhered to each QI and to all applicable indicators (overall physician adherence). Logistic regression analysis examined association of overall physician adherence with sociodemographics, health care utilization, comorbidity, and provider characteristics. Results. Of 3,658 patients with a diagnosis of gout, 663 patients qualified for examination of >1 QI. Of these 663 patients, therapy in only 144 (22%) adhered to all applicable QIs; 59 (78%) of 76 adhered to QI 1, 155 (24%) of 643 adhered to QI 2, and 18 (35%) of 52 adhered to QI 3. Overall physician adherence to QIs was significantly lower in older veterans and in those with more inpatient visits per year, but was higher in those with more primary care visits or more health care providers. Conclusion. Suboptimal physician adherence to QIs was seen for all 3 QIs tested in this cohort of veterans with gout. These findings can guide quality improvement efforts.

Methods for Developing the American College of Rheumatology's Electronic Clinical Quality Measures

“…Among the high-impact Medicare conditions examined, both RA and osteoporosis were ranked among the top 20 national priorities for measure development (9). Although gout was not identified as a Medicare priority, the subcommittee recommended that gout be considered a priority condition given demonstrated gaps in quality of care (10)(11)(12).…”

Febuxostat for Treatment of Chronic Hyperuricemia in Gout Patients

“…К причинам увеличения частоты гиперурикемии среди насе-ления разных стран мира относятся увеличение потребле-ния продуктов, богатых пуринами, безалкогольных напитков с фруктозой, а также увеличение потребления алкоголя [12]. Кроме того, глобальное распространение ожирения также способствует «эпидемии» гиперурикемии [6,7,9] Следует отметить, что подагра связана со значитель-ными экономическими затратами [13,14]. Так, длитель-ность временной нетрудоспособности у пациентов с подагрой моложе 65 лет составляет 25,1 дня в год, а эпизоды острой подагры приводят к потере в среднем 17,1 дня трудоспособности в год [15].…”

Target Serum Urate: Do Gout Patients Know Their Goal?

“…Although substantial attention in gout has been given to suboptimal adherence to quality-of-care indicators among providers (12)(13)(14) and low SU goal attainment among patients (15,16), to what extent patients understand gout and their treatment is largely unknown. Patients report that they are concerned, but uninformed, about whether or not ULT triggers gout attacks (17).…”