Session Information
Session Title: Metabolic and Crystal Arthropathies: Clinical Aspects
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Treat-to-target approaches are used to achieve therapeutic goals in conditions such as diabetes and rheumatoid arthritis. This strategy has also been widely endorsed in gout using urate lowering therapy (ULT). However, suboptimal rates of serum urate (sUA) goal achievement and ULT dose titration in clinical data indicate that providers are not routinely adopting treat-to-target strategies in gout. According to the Chronic Care Model a viable strategy for improving outcomes may be to directly engage gout patients in their care, an approach that requires patient knowledge of sUA goals. The objective of this study was to examine knowledge of sUA goals among gout patients treated with ULT and to identify factors associated with this knowledge.
Methods:
Questionnaires were mailed to 1437 gout patients receiving an allopurinol prescription between August 1, 2011 and July 31, 2012. Of these, 886 (62%) surveys were returned. Patients were asked in a multiple choice format “What is the ideal blood uric acid level to aim for when treating gout?” In addition to sociodemographic, health, and gout-related factors, analysis included Patient Activation Measure (PAMTM) scores which quantifies an individual’s self-perceived combination of skills, knowledge and confidence necessary to become engaged in their own care (range 0 to 100). A continuous measure, PAMTM scores are categorized into 4 levels from low activation (1) to high activation (4). Associations of factors with knowledge were examined using multivariable logistic regression.
Results:
Only 13% of patients correctly identified a sUA goal for ULT (< 6.0 mg/dl); 78% reported that they “didn't know” and 9% chose an incorrect answer (Table 1). This was despite a generally high level of knowledge about gout including its cause (87% correct), cause of acute flares (69%), classic symptoms (93%), use of allopurinol as ULT (83%) and indefinite duration of ULT (69%). Older age and PAMTM score were independently associated with knowing the target sUA. An increase of 15 points was associated with a 32% increase in the odds of knowing goal sUA.
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Table 1. Association of Patient Characteristics with Knowledge of Target Serum Urate Among Gout Patients Receiving Urate Lowering Therapy
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Bivariate |
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Multivariable |
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|
Knew |
Did not know |
P |
|
Odds Ratio (95% CI) |
P |
|
|
N = 886 |
109 (13%) |
755 (87%) |
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|
|
|
|
Age, mean (SD) |
69.6 (10.3) |
72.8 (10.2) |
<0.01 |
|
0.974 (0.954-0.994) |
0.011 |
|
Male |
108 (99%) |
744 (99%) |
0.54 |
|
|
|
|
Non-Hispanic Caucasian * |
95 (89%) |
677 (91%) |
0.54 |
|
|
|
|
Married * |
63 (59%) |
425 (57%) |
0.64 |
|
|
|
|
High school graduate * |
99 (93%) |
661 (88%) |
0.12 |
|
|
|
|
Body mass index |
32.7 (5.1) |
32.2 (6.3) |
0.31 |
|
|
|
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Age at first gout attack |
47.4 (15.8) |
50.3 (15.4) |
0.07 |
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|
|
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Serum urate at diagnosis |
7.3 (2.0) |
7.0 (2.1) |
0.16 |
|
|
|
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Patient activation score (0-100 scale) |
62.6 (11.5) |
59.4 (11.6) |
0.01 |
|
1.019 (1.001-1.037) |
0.044 |
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Confidence (0-10 scale)† , median (SD) |
8.8 (2.0) |
8.8 (2.4) |
0.32 |
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Values in bivariate analysis are frequency (%) or mean (±SD) except where noted. * The following variables were dichotomized for analysis: non-Hispanic Caucasian vs. other, currently married vs. not married and high school graduate vs. less than high school graduate. † Composite average confidence in 4 aspects of the treatment plan: discussion of medication, discussion of lifestyle and diet, able to summarize the plan and able to do all the tasks in the plan. |
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Conclusion:
In this population, we observed a lack of knowledge among ULT-treated gout patients about target sUA levels. Younger patients and those demonstrating lower activation were more likely to be deficient in knowledge of their sUA goal. Interventions to improve outcomes among gout patients may benefit from improving activation.
Disclosure:
B. W. Coburn,
None;
K. A. Bendlin,
None;
H. Sayles,
None;
K. S. Hentzen,
None;
M. M. Hrdy,
None;
T. R. Mikuls,
None.
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