Health care utilization in patients with gout: a prospective multicenter cohort study

BMC Musculoskeletal Disorders

Research Article

Jasvinder A. Singh¹  Aseem Bharat²  Erin Duffy³  David Elashoff³  Dinesh Khanna⁴  Puja P. Khanna⁵  Jay E. Persselin⁶  Cleopatra Aquino-Beaton⁶ 

[1] Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, 35294, Birmingham, AL, USA;Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA;Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA;Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA;University of California, Los Angeles, CA, USA;University of Michigan, Ann Arbor, MI, USA;University of Michigan, Ann Arbor, MI, USA;VA Ann Arbor Healthcare System, Ann Arbor, MI, USA;VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA;

关键词: Gout;    Utilization;    Predictors;    Health care utilization;    Flares;   

DOI  :  10.1186/s12891-017-1573-6

 received in 2016-12-05, accepted in 2017-05-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAll published studies of health care utilization in gout have been cross-sectional to date, and most used a patient-reported diagnosis of gout. Our objective was to assess health care utilization and its predictors in patients with physician-confirmed gout in a prospective cohort study.MethodsIn a multi-center prospective cohort study of U.S. veterans with rheumatologist-confirmed gout (N = 186; two centers), we assessed patient self-reported overall and gout-specific health care utilization with the Gout Assessment Questionnaire (GAQ) every 3-months for a 9-month period. Comparisons were made using the student’s t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate. Mixed effects Poisson regression was used to assess potential correlates of gout-related health care utilization.ResultsMean age was 64.6 years, 98% were men, 13% Hispanic or Latino, 32% were African-American, 6% did not graduate high school, mean serum urate was 8.3 and mean Deyo-Charlson score was 3.1. During the past year, mean gout-related visits were as follows: rheumatologist, 1.5; primary care physician, 2 visits; ≥1 inpatient visits, 7%; ≥1 ER visits, 26%; and urgent care/walk-in visit, 33%. In longitudinal analyses, African-American race and gout flares in the last 3 months were associated with significantly higher rate ratio of gout-related outpatient visits. African-American race and lack of college education were associated with significantly higher rate ratio for gout-related urgent visits and overnight stays.ConclusionsAfrican-American race and recent gout flares were associated with higher outpatient utilization and African-American race and no college education with higher urgent or inpatient utilization. Future studies should examine whether modifiable predictors of utilization can be targeted to reduce healthcare utilization in patients with gout.

【 授权许可】

CC BY   
© The Author(s). 2017