Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

Jasvinder A. Singh, MBBS, MPH¹, James Hodges, PhD², David B. Nelson, PhD³, and Joanne Thomas, MS². (1) Medicine, Minneapolis VA Medical Center, One Veterans Drive, Rheumatology (111 R), Minneapolis, MN 55417, 612-467-4190, jasvinder.singh@va.gov, (2) Center for Chronic Diseases Outcomes and Research, Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN 55417, (3) Center for Chronic Diseases Outcomes Research, Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN 55417

Objective: To assess if veterans with a diagnosis of gout receive quality care as measured by adherence to peer-reviewed evidence-based gout quality indicators (QI).

Methods: This was a Retrospective Cohort Study involving primary data collection from Minneapolis Veterans Affairs Medical Center (VAMC) clinical and administrative databases.

We identified a cohort of veterans who had International Classification of Diseases (ICD)-9 codes for diagnosis of gout and were prescribed medication for treatment of gout including allopurinol, colchicine, or probenecid in the period 1999 to 2003. Cohort laboratory data including complete blood count (CBC), creatine kinase (CK), creatinine and uric acid were obtained. We examined three quality indicators (QI) in our cohort: QI (1) If a gout patient is receiving an initial prescription for allopurinol and has renal insufficiency with creatinine >= 2mg/dl, then allopurinol dose should be < 300 mg/day; QI (2) If a gout patient is given a new prescription for allopurinol, uric acid should be checked within six-months; QI (3) If a gout patient receives long-term prophylactic oral daily colchicine of >= 0.5 mg/day and has renal insufficiency with creatinine >=2mg/dl, then CBC and CK should be checked at least once for every 6 month use. Adherence to each QI was measured as the percentage of patients who met the respective QI standard.

Results: 3,658 patients had gout (98% had ICD-9 code for gouty arthritis/arthropathy, 3% for tophaceous gout and 2% for gout with renal involvement). 2,223/3,658 (61%) were prescribed one or more gout medications: Allopurinol (51%), colchicine (25%) and probenecid (3%).

Nearly one-third (34/111; 31%) of patients with creatinine >=2mg/dl were prescribed >=300 mg of allopurinol per day i.e. non-adherent to QI (1). Of greater concern was the finding that 67% of the 542 patients started on allopurinol did not have a uric acid checked within 6 months of initiation of allopurinol therapy i.e. non-adherent to QI (2). 75% of the 24 patients with creatinine >=2mg/dl who were prescribed daily colchicine for >=6 months did not have CBC and CK checked within the 6-month period i.e. non-adherent to QI (3).

Conclusions: These data indicate very poor adherence to peer-reviewed published quality of care indicators for gout management. Poor adherence may increase the risk for clinically important adverse outcomes. Major efforts to change practice behaviors will be needed to improve quality of gout care.

Learning Objectives:

• To describe the variable adherence to quality indicators for gout care in veterans
• To recognize the opportunity for improvement of care for patients with gout

Keywords: Quality of Care, Veterans

Presenting author's disclosure statement:

Any relevant financial relationships? Yes

Organization	Clinical/Research Area	Type of Relationship
TAP Pharmaceuticals	Gout	Other (please describe) and Research grant
Abbott Pharmaceuticals	Treatment of Inflammatory arthritis	Speaker's bureau and teaching engagements

Any company-sponsored training?	Yes
Did the company pay your travel and lodging?	No
Were you provide you with slides as part of the training sessions?	No
Did you receive an honorarium or consulting fee for participating in the training?	Yes
Any institutionally-contracted trials related to this submission?	No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Recorded presentation