Gout
Health Care Utilization in Patients with Gout

https://doi.org/10.1016/j.semarthrit.2010.07.001Get rights and content

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.

Section snippets

Methods

This study was conducted as part of a larger study validating a new gout-specific health-related quality-of-life instrument (8). The sample was recruited from gout patients attending a variety of clinics (eg, rheumatology, primary care) in 3 U.S. cities (San Diego, Cincinnati, and Minneapolis) using physician in-office recruitment, patient response to clinic posters, and local newspaper advertisements. Inclusion criteria were as follows: age between 18 and 85, presence of gout as determined by

Results

The original cohort consisted of a total of 298 patients who completed the study questionnaire. Of the original cohort, 296 (99.3%) provided utilization data and are included in the current study (Fig. 1). Physicians responded for 224 patients, with gout diagnosis confirmed for 202 of the patients for whom physicians provided supporting data (90.2%). Sixty percent of patients were recruited from the 3 VA medical centers and 40% from private practices.

Demographic and clinical information about

Discussion

In our study, primary care physician visits were the most frequently cited health care resource for gout treatment and rheumatologist visits were the second most frequently used resource. Patients used each of these visit types an average of 3 times in the year before the survey. Slightly more than 1/3 of patients had used emergency room or urgent care facilities for their gout treatment, which is more costly than outpatient care. Our overall gout severity composite measure, physician-rated

Acknowledgments

This work was supported in part by an investigator-initiated research grant from Takeda Pharmaceutical Products, Inc, VA Research Service, and the University of California, San Diego General Clinical Research Center Program, M01 RR00827, National Center for Research Resources, National Institutes of Health.

References (29)

  • H.M. Kramer et al.

    The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988-1994

    Am J Kidney Dis

    (2002)
  • K.Y. Kim et al.

    A literature review of the epidemiology and treatment of acute gout

    Clin Ther

    (2003)
  • R.A. Brook et al.

    The economic burden of gout on an employed population

    Curr Med Res Opin

    (2006)
  • E.Q. Wu et al.

    Disease-related and all-cause health care costs of elderly patients with gout

    J Manag Care Pharm

    (2008)
  • J.G. Hanly et al.

    Gout in the elderly—a population health study

    J Rheumatol

    (2009)
  • J.A. Singh et al.

    Gout is associated with more comorbidities, poorer health-related quality of life and higher healthcare utilization in US veterans

    Ann Rheum Dis

    (2008)
  • R. Halpern et al.

    The effect of serum urate on gout flares and their associated costs: an administrative claims analysis

    J Clin Rheumatol

    (2009)
  • J.D. Hirsch et al.

    Evaluation of an instrument assessing influence of gout on health-related quality of life

    J Rheumatol

    (2008)
  • S.L. Wallace et al.

    Preliminary criteria for the classification of the acute arthritis of primary gout

    Arthritis Rheum

    (1977)
  • J.R. Ragazzini et al.

    A mathematical technique for the analysis of linear systems

    Proc IRE

    (1954)
  • A. Shoji et al.

    A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy

    Arthritis Rheum

    (2004)
  • J. Cohen et al.

    Applied multiple regression/correlation analysis for the behavioral sciences

    (2003)
  • E. Arromdee et al.

    Epidemiology of gout: is the incidence rising?

    J Rheumatol

    (2002)
  • P.W. Bull et al.

    Intermittent control of hyperuricemia in the treatment of gout

    J Rheumatol

    (1989)

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    This work was supported by the Takeda Pharmaceutical Products, Inc, VA Research Service and the University of California, San Diego General Clinical Research Center Program,M01 RR00827, National Center for Research Resources, National Institutes of Health. D.K. was also supported by a National Institutes of Health Award (NIAMS K23 AR053858-01A1) during this period. J.A.S. was supported by a National Institutes of Health CTSA Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research). R.T. was supported by the VA Research Service.

    Disclosure Statement: J.A.S. has received speaker honoraria from Abbott, research grants from Department of Veterans Affairs, National Institutes of Health, Arthritis Foundation, University of Minnesota, Cochrane centers, Minnesota Medical Foundation, research and travel grants from Allergan, Takeda, Savient, Wyeth, and Amgen and consultant fees from Savient, URL Pharmaceuticals, and Novartis. J.D.H. has received a research grant from TAP and Takeda pharmaceuticals and consultant fees from Regeneron. R.T. is a consultant for Takeda, Savient, EnzymeRx, Altus, BioCryst, Regeneron, Novartis, Pfizer, URL Pharma, and Proctor & Gamble and has received grants from the Research Service of the Department of Veterans Affairs and Takeda Pharmaceuticals. D.K. has received consultant fees and research grants from Takeda Pharmaceuticals. A.K. has received consultant fees from URL pharmaceuticals. All other authors have no conflicts of interest to disclose.

    “The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.”

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