Opportunities for improving medication use and monitoring in gout.
OBJECTIVE
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 <or=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 <or=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 <or=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.
Singh
J A
JA
Minneapolis VA Medical Center, Rheumatology Section, One Veteran's Drive, Minneapolis, MN 55417, USA. Jasvinder.md@gmail.com
Hodges
J S
JS
Asch
S M
SM
D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003078:Colchicine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D005260:Female; D006073:Gout / Q000097:blood / Q000188:drug therapy*; D006074:Gout Suppressants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011339:Probenecid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011787:Quality of Health Care; D051437:Renal Insufficiency / Q000139:chemically induced; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
D015415:Biomarkers; D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol; D011339:Probenecid; D003078:Colchicine