Management of Gout in the United States: A Claims-based Analysis
N Lawrence Edwards1, Naomi Schlesinger2, Sanders Clark3
1University of Florida, Gainesville, Florida.
Insights
Gout management lacks consistency in real-world practice. Seeing a rheumatologist improves serum urate testing and urate-lowering therapy prescriptions, potentially improving patient outcomes.
Area of Science:
- Rheumatology
- Clinical Practice Research
- Health Services Research
Background:
- Gout is a prevalent inflammatory arthritis in the US.
- Existing gout management guidelines are often not implemented in routine practice.
- Real-world practice patterns require evaluation to identify care gaps.
Purpose of the Study:
- To evaluate real-world practice patterns in gout patient care.
- To assess the utilization of serum urate testing and urate-lowering therapies (ULTs).
- To examine the impact of rheumatologist care on gout management and outcomes.
Main Methods:
- Analysis of large administrative claims databases (Symphony Integrated Dataverse and Truven Marketscan).
- Identification of over 1.1 million adult gout patients from October 2015 to November 2018.
- Evaluation of serum urate testing, rheumatology visits, ULT prescriptions, and emergency room visits for gout flares.
Main Results:
- Gout patients were primarily managed by internists and family medicine practitioners.
- Serum urate testing and ULT prescriptions showed significant variability.
- Rheumatologist care was associated with increased urate testing, ULT prescriptions, and decreased emergency room visits for gout flares.
Conclusions:
- Serum urate measurement and ULT prescriptions are inconsistent in gout patient care.
- Rheumatologist involvement enhances the frequency of key management interventions.
- Specialist rheumatologist care may lead to improved outcomes for gout patients.
Objective:
Gout is the most common inflammatory arthritis in the United States. Although numerous guidelines exist for the management of gout, they are not routinely implemented. This study evaluated the real-world practice patterns in gout patients using large administrative claims databases.
Methods:
An analysis of patients diagnosed with gout from October 2015 to November 2018 was carried out using the Symphony Integrated Dataverse and Truven Marketscan administrative claims databases. Patients were identified as having gout if they were more than18 years of age and had 2 or more primary gout diagnoses on different days, separated by 3 or more months. Patients were further identified as having either acute gout or advanced forms of gout including chronic nontophaceous, tophaceous, and uncontrolled gout. Percent and frequency of serum urate testing, rheumatology specialist visits, prescriptions for urate lowering therapies (ULTs), and emergency room (ER) visits for gout flares were evaluated.
Results:
We identified 1 162 747 gout patients. Gout patients were seen most frequently by internists and family medicine practitioners. Neither urate testing nor prescriptions for ULTs were uniform. Patients with acute gout were infrequently seen by rheumatologists, whereas rheumatologist care progressively increased in patients with advanced gout. The frequency of serum urate testing and prescriptions for ULTs significantly increased, whereas the frequency of ER visits decreased in gout patients seen by a rheumatologist.
Conclusion:
Measurement of serum urate and prescriptions for ULTs are not consistent in gout patients. Rheumatologist care increases the frequency of urate measurement and ULT prescriptions and may also improve outcomes for gout patients.
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