Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD)

Mikuls, Ted R.; Farrar, John T.; Bilker, Warren B.; Fernandes, S.; Saag, Kenneth G.

doi:10.1093/rheumatology/keh679

Cited by 141 publications

(100 citation statements)

References 26 publications

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“…The overall rate of 22% physician adherence to all 3 QIs is similar to results from the UKGPRD study that also examined 3 QIs. The QIs in the UK study included allopurinol use in patients with asymptomatic hyperuricemia, allopurinol dosing in renal failure, and concomitant allopurinol use in patients receiving azathioprine or 6-mercaptopurine (16). Our finding that 22% of patients with renal insufficiency received higher-thanrecommended allopurinol doses confirms the analogous rate of 25% in the UK study.…”

Section: Discussionsupporting

confidence: 77%

“…It is of concern that 22% of our patients with renal insufficiency received higher-than-recommended allopurinol doses, similar to the 25% noncompliance rate found in an earlier study (16). Two previous studies reported inappropriately high allopurinol doses in patients with renal insufficiency, 47% in elderly adults (10) and 39% in adults (11).…”

Section: Discussionsupporting

confidence: 76%

“…Our study and the study by Mikuls et al (16) extend this observation of suboptimal care to include gout patients using evidencebased quality indicators.…”

Section: Quality Of Care For Veterans With Diagnosis Of Goutsupporting

confidence: 65%

“…These quality indicators (QIs) are minimum acceptable standards of care that have been directly or indirectly linked to outcomes in published clinical studies, and that are believed by the experts to produce good outcomes. Mikuls et al examined 3 QIs in the UK General Practitioner Research Database (UKGPRD) and found low (25-57%) physician adherence (16). Studies in US health plans have found gaps in quality care for gout (17,18).…”

Section: Introductionmentioning

confidence: 99%

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Quality of care for gout in the US needs improvement

Singh

Hodges

Toscano

et al. 2007

Arthritis & Rheumatism

174

109

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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.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 76%

“…Our study and the study by Mikuls et al (16) extend this observation of suboptimal care to include gout patients using evidencebased quality indicators.…”

Section: Quality Of Care For Veterans With Diagnosis Of Goutsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Quality of care for gout in the US needs improvement

Singh

Hodges

Toscano

et al. 2007

Arthritis & Rheumatism

174

109

View full text Add to dashboard Cite

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“…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).…”

Section: Introductionmentioning

confidence: 99%

Target Serum Urate: Do Gout Patients Know Their Goal?

Coburn

Bendlin

Sayles

et al. 2016

Arthritis Care & Research

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Objective. To examine gout patients' knowledge of their condition, including the central role of achieving and maintaining the serum urate (SU) goal with the use of urate-lowering therapy (ULT).Methods. This study of 612 gout patients was conducted at a Veterans Affairs medical center. Gout patients were included based on administrative diagnostic codes and receipt of at least 1 allopurinol prescription over a 1-year period. Questionnaires were mailed to patients and linked to medical records data. The questionnaire included goutspecific knowledge questions, the Patient Activation Measure, and self-reported health outcomes. Knowledge was assessed descriptively. Multivariable logistic regression was used to determine predictors of SU goal knowledge. Associations of knowledge with health outcomes were examined in exploratory analyses. Results. The questionnaire had a 62% response rate. Only 14% of patients knew their SU goal, while the majority answered correctly for the other 5 gout-specific knowledge questions. In adjusted analyses, having a rheumatologist as initial prescriber (odds ratio [OR] 3.0 [95% confidence interval (95% CI) 1.4-6.2]) and knowing all of the other 5 gout-specific knowledge questions (OR 2.1 [95% CI 1.3-3.4]) were associated with greater odds of knowing the SU goal. SU goal knowledge was associated with self-reported global health status, but not with self-reported health-related quality of life or gout-specific health status. Conclusion. There is a knowledge deficit regarding the SU treatment goal among gout patients receiving ULT, despite generally high levels of other gout-specific knowledge. SU goal information may be an important and underutilized concept among providers treating gout patients.

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Management of Gout

Shmerling

2012

JAMA

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Mr R is a 57-year old man with a history of podagra (acute first metatarsal-phalangeal joint pain and swelling), hyperuricemia, and mild chronic kidney disease. An immigrant from Eastern Europe, Mr R worked as an engineer and is now retired. He lives with his wife and has several children. For many years, he has been a patient at a hospital-based primary care practice. He has a 60-packyear history of smoking but does not abuse alcohol or other drugs. He has no family history of gout, but his grandfather and father had renal disease of uncertain etiology.In 1993, Mr R experienced his first episode of podagra and was treated with indomethacin and an "injection into my toe." Five years later, his first measurement of uric acid was 7.7 mg/dL. Over the next 10 years, recurrent episodes of podagra were accompanied by uric acid levels as high as 9 mg/dL. Treatment with colchicine caused diarrhea without pain relief. He has adamantly refused further colchicine treatment. A consulting rheumatologist recommended that he use ibuprofen as his principal medication during acute episodes. In 2006, his serum creatinine level was first elevated to 1.3 mg/dL (with an estimated glomerular filtration rate of 57 mL/min/1.73 m 2 ); it later increased to 1.5 mg/dL but stabilized more recently at 1.3 mg/dL. He has had microalbuminuria, most recently with an albumincreatinine ratio of 442 mg/g (normal range, Ͻ30 mg/g). Aside from the presence of 2 cysts, kidney size and architecture were unremarkable on ultrasound and computed tomography.At the time of the elevation in creatinine, Mr R started therapy with allopurinol, 100 mg/d, which he continues. His uric acid levels range between 6 and 7 mg/dL. He has never had physical stigmata of gout other than intermittent swelling, redness, and pain in his great toe. He has not had recurrent symptoms since initiating allopurinol. Mr R has long-standing obesity. His height is 68 in (173 cm); weight, 258 lb (116 kg); and body mass index (calculated as weight in kilograms divided by height in meters squared), 39.2. His blood pressure has been mildly elevated. He has a long history of hyperlipidemia. Currently, his low-density lipoprotein cholesterol level is 172 mg/dL (ideal range, Ͻ129 mg/dL). He currently takes rosuvasta- CME available online at www.jamaarchivescme.com and questions on p 2154.Gout is an ancient disease. Despite significant advances in the understanding of its risk factors, etiology, pathogenesis, prevention, and treatment, millions of people with gout experience repeated attacks of acute arthritis and other complications. The incidence of gout is increasing, most likely reflecting increasing rates of obesity and other lifestyle factors, including diet. Comorbid conditions that often accompany gout, including chronic kidney disease and diabetes mellitus, present challenges for the management of gout. Using the case of Mr R, a 57-year-old man with a history of podagra, hyperuricemia, and mild renal insufficiency, the diagnosis and treatment of gout are discussed. For those with mode...

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Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD)

Cited by 141 publications

References 26 publications

Quality of care for gout in the US needs improvement

Quality of care for gout in the US needs improvement

Target Serum Urate: Do Gout Patients Know Their Goal?

Management of Gout

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