Background Gout is quite prevalent among United States veterans and many do not achieve optimal levels of uric acid (< 6 mg/dl).1 This suggests that there are large number of veterans who are at risk for gout flare, leading to utilization of health care resources such as emergency department (ED) and outpatient office visits. We investigated the ED visit patterns among veterans with history of gout and the factors contributing to ED visits.
Objectives The objectives of the study were to identify the risk factors for ED visits by veterans for gout flare up. Future remediation of the risk factors would reduce utilization of health care resources.
Methods This was a retrospective chart review of veterans diagnosed with gout in the ED at VA Medical Center Memphis TN between January 1st, 2011 and December 31st, 2016 using ICD-9 codes. A rheumatologist reviewed all cases and only confirmed cases of gout were included in the study. There were 2516 veterans seen for acute gout during the study period and of these, random selection of 10% i.e. 250 subjects were considered for the study. Baseline demographics, medical comorbidities, serum uric acid level, medication history, and information whether they were followed by rheumatologist or primary care physician (PCP) were extracted from electronic health record.
We used Stat view Version 5.01 (SAS Institute Inc. Cary, NC) for analysis. We described data with frequency terms, continuous data by mean ± standard deviation, and categorical data by percent. Univariate analysis identified predictors of interest that were later incorporated in the best fit model with logistic regression. A p value of < 0.05 was considered statistically significant.
Results The mean age of subjects was 61 +/-11 years, mean BMI was 32 +/- 7 kg/m2, 98% were males and 80% were African Americans. 26% of subjects had history of alcohol use, 89% had hypertension and 88% had chronic kidney disease (CKD stage ≥2). 86% of the subjects were followed by primary care physician (PCP), and 5% of them were followed by rheumatology and rest of the 9% were non- compliant. 30% of subjects were receiving urate-lowering therapy and 23% of patients were on gout prophylactic therapy. 21% of patients had multiple (≥ 2) visits to the ED. The mean uric acid level was 8.5 ± 2.1 mg/dl for subjects with single visit compared to 9.04± 2.1 mg/dl for multiple visits to the ED (P = 0.09).
In the univariate analysis, CKD (stage ≥ 2) and higher uric acid level were associated with increased ED visits (P = 0.09) and not being on urate lowering therapy was also associated with increased frequency of ED visits (P = 0.02). On logistic regression analysis, irrespective of the type of physician follow up (PCP vs rheumatologists), being on urate-lowering therapy was associated with reduced frequency of ED visits. (P=0.02).
Conclusion Urate-lowering therapy (ULT) was associated with reduced ED visit irrespective of follow up care provided by PCP or rheumatologist. Given that only one third of our patients were on ULT, improving ULT dispensing by the physician and patient compliance with ULT can decrease health care utilization.
Reference  Hughes JC, Wallace JL, Bryant CL, et al. Monitoring of urate lowering therapy among US veterans. Annals of Pharmacotherapy.2017Apr;51(4):301-306
Disclosure of Interests None declared
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