Opportunities for improving medication use and monitoring in gout

Abstract

Purpose: Study patterns/predictors of medication use and laboratory monitoring, in gout.

Methods: In a cohort of veterans with diagnosis of gout, prescribed allopurinol, colchicine or probenecid, we examined quality-of-care by examining adherence to evidence-based recommendations, namely: (1) whether patients starting new allopurinol prescription (a) received continuous allopurinol; (b) received colchicine prophylaxis; (c) achieved target uric acid ≤6 mg/dl; and (2) if doses were adjusted for renal insufficiency. Logistic/Poisson regression examined association of socio-demographics, health care utilization and comorbidity with recommendations.

Results: Of the 643 gout patients receiving a new allopurinol prescription, 46% (297/643) had continuous allopurinol prescription, 10% (66/643) received colchicine prophylaxis and 20% (126/643) reached target uric acid of ≤6 mg/dl. During episodes of renal insufficiency, appropriate dose reduction/discontinuation of probenecid was done in 77% (24/31) episodes and of colchicine in 69% (36/52).

Multivariable regression showed higher outpatient utilization, more rheumatology care and lower comorbidity were associated with better quality-of-care: more rheumatology or primary care visits associated with less frequent allopurinol discontinuation, more total outpatient visit days or most frequent visits to rheumatology clinic with higher likelihood of receiving colchicine prophylaxis, and lower Charlson Comorbidity Index or more outpatient visit days with higher odds of reaching uric acid ≤6 mg/dl.

Conclusions: We found important variation in patterns of medication use and monitoring in gout patients, with suboptimal care. A concerted effort is needed to improve overall gout care.