title: Monitoring of Urate-Lowering Therapy Among US Veterans Following the 2012 American College of Rheumatology Guidelines for Management of Gout.
abstract: BACKGROUND
  With the prevalence of and hospitalizations for gout increasing, optimizing care for patients with gout is imperative. The 2012 American College of Rheumatology gout guidelines emphasize that timely monitoring is key to achieving serum urate (SUA) goals. Few studies have examined this metric following the 2012 update, and to our knowledge, none have examined a veteran population.
  
  
  OBJECTIVE
  To evaluate adherence to urate-lowering therapy (ULT) monitoring guidelines in a veteran population.
  
  
  METHODS
  This is a single-center, multisite, retrospective chart review of US veterans receiving ULT for gout within the VA (Veterans Affairs) Tennessee Valley Healthcare System from January 1, 2013, to June 30, 2015. The primary end point was percentage of patients with a SUA within 6 months of initial xanthine oxidase inhibitor prescription. Secondary end points included percentage of patients with SUA <6 mg/dL and percentage of patients with uptitration following SUA above goal.
  
  
  RESULTS
  A total of 601 patients met inclusion criteria for the study; after application of exclusion criteria, 505 were analyzed. Of these, 295 patients (58%) did not have a SUA drawn within 6 months, and 162 patients (32%) reached the end of the study period without SUA measured. Of 226 patients with SUA above goal on initial check, 64 (28%) had timely dose adjustment, whereas 143 patients (63%) had no adjustment. A total of 161 patients (32%) had a SUA at goal within the study period.
  
  
  CONCLUSIONS
  Rates of ULT monitoring at a major VA medical center were suboptimal, and improved adherence to guideline recommendations is needed.
authors.affiliation: 1 VA Tennessee Valley Healthcare System, Nashville, TN, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Hughes
authors.affiliation: 1 VA Tennessee Valley Healthcare System, Nashville, TN, USA.|2 Lipscomb University College of Pharmacy, Nashville, TN, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Wallace
authors.affiliation: 2 Lipscomb University College of Pharmacy, Nashville, TN, USA.
authors.forename: Candace L
authors.initials: CL
authors.lastname: Bryant
authors.affiliation: 3 VA Tennessee Valley Healthcare System, Murfreesboro, TN, USA.
authors.forename: Brent E
authors.initials: BE
authors.lastname: Salvig
authors.affiliation: 3 VA Tennessee Valley Healthcare System, Murfreesboro, TN, USA.
authors.forename: T Neal
authors.initials: TN
authors.lastname: Fourakre
authors.affiliation: 1 VA Tennessee Valley Healthcare System, Nashville, TN, USA.|4 Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Stone
mesh_terms: D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016903:Drug Monitoring; D000069465:Febuxostat / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006073:Gout / Q000097:blood / Q000188:drug therapy*; D006074:Gout Suppressants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012219:Rheumatology; D013714:Tennessee; D014527:Uric Acid / Q000097:blood*; D014728:Veterans; D014969:Xanthine Oxidase / Q000037:antagonists & inhibitors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants; D000069465:Febuxostat; D014527:Uric Acid; D000493:Allopurinol; D014969:Xanthine Oxidase
keywords: adherence; gout; quality assurance; rheumatology; therapeutic monitoring