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Opportunities for improving medication use and monitoring in gout
  1. J A Singh1,2,3,
  2. J S Hodges2,4,
  3. S M Asch5
  1. 1
    Rheumatology Section, Medicine Service, VA Medical Center, Minneapolis, Minnesota, USA
  2. 2
    Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota, USA
  3. 3
    Division of Rheumatology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4
    Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
  5. 5
    VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  1. Dr J A Singh, Minneapolis VA Medical Center, Rheumatology (111R), One Veteran’s Drive, Minneapolis, MN 55417, USA; Jasvinder.md{at}gmail.com

Abstract

Purpose: To study patterns and predictors of medication use and laboratory monitoring in gout.

Methods: In a cohort of veterans with a diagnosis of gout prescribed allopurinol, colchicine or probenecid, quality of care was assessed by examining adherence to the following evidence-based recommendations: (1) whether patients starting a new allopurinol prescription (a) received continuous allopurinol, (b) received colchicine prophylaxis, (c) achieved the target uric acid level of ⩽6 mg/dl; and (2) whether doses were adjusted for renal insufficiency. The association of sociodemographic characteristics, healthcare utilisation and comorbidity with the recommendations was examined by logistic/Poisson regression.

Results: Of the 643 patients with gout receiving a new allopurinol prescription, 297 (46%) received continuous allopurinol, 66 (10%) received colchicine prophylaxis and 126 (20%) reached the target uric acid level of ⩽6 mg/dl. During episodes of renal insufficiency, appropriate dose reduction/discontinuation of probenecid was done in 24/31 episodes (77%) and of colchicine in 36/52 episodes (69%). Multivariable regression showed that higher outpatient utilisation, more rheumatology care and lower comorbidity were associated with better quality of care; more rheumatology clinic or primary care visits were associated with less frequent allopurinol discontinuation; more total outpatient visit days or most frequent visits to a rheumatology clinic were associated with a higher likelihood of receiving colchicine prophylaxis; and a lower Charlson Comorbidity Index or more outpatient visit days were associated with higher odds of reaching the target uric acid level of ⩽6 mg/dl.

Conclusions: Important variations were found in patterns of medication use and monitoring in patients with gout with suboptimal care. A concerted effort is needed to improve the overall care of gout.

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Footnotes

  • Competing interests: None.

  • The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

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