Background/Purpose: Because of the chronic nature of the disease, gout is associated with more co-morbidities, poor health-related quality of life (HRQoL) and more healthcare utilization (HCU). Therefore, the cost of care associated with gout management is rising. There is lack of evidence that describes the predictions of health care utilization in patients with gout. The objective of this study is to assess health care utilization and its predictors in patients with gout.

Methods: We conducted a prospective cohort study of 186 veterans with gout (predominantly male) recruited at Veterans Affairs (VA) rheumatology and primary care clinics at the West Los Angeles, CA and Birmingham, AL facilities. We assessed overall health care utilization with the patient self-reported University of California at San Diego (UCSD) Health Care Utilization Questionnaire and gout-specific health care utilization on the Gout Assessment Questionnaire (GAQ) every 3 months for a 9-month period. We collected data including patient demographics, education level, comorbidity, serum urate (in mg/dl) and patient and physician rating of the severity of gout on a 0-10 scale, HRQOL assessment with SF-36, and the Gout Impact Scales (GIS) of the GAQ and functional ability assessed with Health Assessment Questionnaire-Disability Index (HAQ-DI), were assessed. Comparisons were made using the student’s t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate. Zero-inflated Poisson regression was used to assess potential predictors of gout-related HCU.

Results:  The cohort mean age was 64.6 years, 98% were men, 13% Hispanic or Latino, 6% did not graduate high school, the mean serum urate was 8.3, mean physician gout severity assessment was 3.1 and mean patient gout severity assessment was 5.7. Mean Deyo-Charlson score was 3.1.

Overall health care Utilization: There were a mean of 3.9 visits to the health care provider in the past 3 months and 1.7 telephone calls to the provider or medical staff (Table).  17% had 1 or more inpatient visits in the past 3 months, 41% had 1 or more ER/urgent care/triage center visits and 16% with any outpatient procedure or surgery (Table).

Gout-specific health care utilization: During the past year, patients had a mean of 1.5 visits to rheumatologist, 2 visits to primary care doctor (Table).  7% had 1 or more inpatient visits in the past year related to gout, 26% had 1 or more ER visits related to gout and 33% with any urgent care/walk-in visit related to gout (Table 2).

Conclusion: This cohort study is the first prospective cohort study to examine health care utilization in patients with gout. We have described patterns of health care utilization by patients with gout in the U.S. Future studies need to examine whether modifiable predictors of utilization can be targeted to reduce the overall and gout-related utilization in patients.

 

Healthcare Utilization
	Patients with at least one visit/call						Number of visits/calls
	N			%			Mean (SD)
	Total N=186	BHAM N=74	LA N=112	Total N=186	BHAM N=74	LA N=112	Total N=186		BHAM N=74		LA N=112
Overall HCU, prior 3 months:
Number of visits to MD, DO, or NP	163	63	100	92 %	88 %	95 %	3.9	(4.3)	2.8	(2.5)	4.6	(5.1)
Number of phone calls to MD or medical staff	85	32	53	48 %	44 %	50 %	1.7	(3.1)	1.4	(2.3)	1.9	(3.5)
Number of times to a triage, urgent care center, or emergency room	74	31	43	41 %	43 %	40 %	0.6	(0.9)	0.6	(0.9)	0.6	(1.0)
Number of home visits by healthcare provider	16	6	10	9 %	8 %	9 %	0.6	(2.4)	0.5	(1.9)	0.6	(2.8)
Number of days as inpatient	31	11	20	17 %	15 %	19 %	1.8	(9.6)	0.6	(1.6)	2.7	(12.3)
Number of outpatient surgeries or procedures	27	15	12	16 %	23 %	12 %	0.3	(0.9)	0.4	(1.1)	0.2	(0.7)
Gout related HCU, prior year:
Rheumatologist	97	20	77	53 %	28 %	70 %	1.5	(2.0)	1.2	(2.4)	1.7	(2.4)
Primary Care Doctor	128	57	71	71 %	79 %	66 %	2.0	(1.9)	2.0	(1.5)	2.0	(1.5)
Nurse Practitioner or Physician’s Assistant	53	8	45	31 %	12 %	43 %	0.8	(1.6)	0.2	(0.7)	1.2	(0.7)
Walk-in or Urgent Care Clinic	57	21	36	33 %	31 %	34 %	0.7	(1.5)	0.6	(0.9)	0.8	(0.9)
Emergency Room at a hospital	45	22	23	26 %	31 %	22 %	0.4	(0.8)	0.4	(0.8)	0.4	(0.8)
Hospital Over-night Stay	17	5	12	10 %	7 %	11 %	0.7	(7.5)	0.1	(0.4)	1.1	(0.4)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/health-care-utilization-in-gout-patients-a-prospective-multicenter-cohort-study/