Measuring quality of gout management in residential aged care facilities

Abstract ObjectivesGout, a common form of arthritis, can be successfully controlled with pharmacotherapy and thus an ideal model for examining chronic disease management. Our aim was to examine treatment of gout evaluated in accordance with general management guidelines for gout as applied to Australian residential aged care facilities (RACFs).MethodsElectronic health record data linked with aged care clinical notes and electronic medication administration information (11,548 residents in 68 RACFs, over 65 years) was interrogated to identify people with gout, other chronic conditions and gout medication use. Outcomes examined: 1) proportion receiving urate-lowering therapy (ULT) (preventative medication) and/or colchicine/non-steroidal anti-inflammatory drugs (NSAID) (treat gout flares); 2) number of ULT and colchicine/NSAID treatment episodes (periods of continuous days of medication use); 3) duration of these medication uses.ResultsCohort included 1179 residents with gout, of which 62% used a ULT, with median of one episode of use for a very short duration (median=4 days, median of use in total (i.e. repeated use)=52 days). Among residents with gout, 9% also used colchicine or an NSAID. Female residents were less likely to receive ULT and for shorter periods.ConclusionNearly a third of residents with gout did not receive ULTs. In those receiving ULT, recurrent short courses were common. Overall, management of gout in aged care residents appears to be suboptimal, largely due to intermittent and short exposure to ULT, and with female residents at greater risk of poor gout management.