title: Health care utilization in patients with gout.
abstract: OBJECTIVE
  To study health care utilization patterns in patients with gout.
  
  
  METHODS
  In a gout population from primary care and rheumatology clinics in 3 U.S. metropolitan cities, we collected data on gout-related utilization (primary care, rheumatology, urgent care, emergency room, and other) in the past year. We evaluated the association of comorbidities, age, gender, gout characteristics (time since last gout attack and tophi), and gout severity ratings (mean of serum uric acid, patient-rated, and physician-rated gout severity) and with emergency/urgent care and primary care utilization using regression and correlation analyses.
  
  
  RESULTS
  Of the 296 patients who reported visiting at least 1 type of health practitioner for gout in the past year, the percentage of patients utilizing the service at least once and annual utilization rates among utilizers were as follows: primary care physician, 60%, 3.0 ± 3.4; nurse practitioner/physician assistant, 26%, 2.7 ± 2.5; rheumatologist, 51%, 3.7 ± 5.7; urgent care, 23%, 2.1 ± 2.2; emergency room, 20%, 2.0 ± 1.7; and hospitalization, 7%, 2.1 ± 1.4. Higher overall gout severity was associated with greater use of each resource type and with overall gout-related utilization. Nonemergency/nonurgent care utilization (primary care physician, nurse practitioner, physician's assistant, and rheumatologist for gout) was the strongest predictor of gout-related emergency/urgent care utilization. Patients with more comorbidities had greater gout-related primary care utilization.
  
  
  CONCLUSIONS
  Overall gout severity was associated with all types of gout-related utilization. This may help to screen high utilizers for targeted behavioral and therapeutic interventions. Having a higher number of comorbid conditions was a risk factor for higher gout-related primary care utilization.
authors.affiliation: Birmingham VA Medical Center and University of Alabama 35294, USA. Jasvinder.md@gmail.com
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.forename: A
authors.initials: A
authors.lastname: Sarkin
authors.forename: M
authors.initials: M
authors.lastname: Shieh
authors.forename: D
authors.initials: D
authors.lastname: Khanna
authors.forename: R
authors.initials: R
authors.lastname: Terkeltaub
authors.forename: S J
authors.initials: SJ
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Kavanaugh
authors.forename: J D
authors.initials: JD
authors.lastname: Hirsch
mesh_terms: D015897:Comorbidity / Q000639:trends; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006073:Gout / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014481:United States; D014504:Urban Health