A national survey of Veterans Affairs Rheumatologists for relevance of quality of care indicators for Gout management

Authors

  • Jasvinder A. Singh,

    Corresponding author
    1. Birmingham VA Medical Center and University of Alabama, Birmingham, and Mayo Clinic School of Medicine, Rochester, Minnesota
    • University of Alabama, Faculty Office Tower 805B, 510 20th Street South, Birmingham, AL 35294
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    • Dr. Singh has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Abbott, Savient, and URL Pharmaceuticals, and has received research and travel grants from Allergan, Takeda, Savient, Wyeth, and Amgen.

  • Michael D. Alpert,

    1. Yale School of Medicine, New Haven, Connecticut, and VA Medical Center, Georgetown, and Howard University Hospitals, Washington, DC
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  • Gail Kerr

    1. VA Medical Center, Georgetown, and Howard University Hospitals, Washington, DC
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    • Dr. Kerr has received speaking fees and/or honoraria (less than $10,000 each) from Abbott, Amgen, and Bristol-Myers Squibb, and has received research grants from Abbott, Amgen, and Savient.


Abstract

Objective

To determine the relevance of current gout quality indicators (QIs).

Methods

Members of the Veterans Affairs (VA) Rheumatology Consortium were invited to participate in an online survey and provide opinions (rank 0–10) regarding existing gout QIs. Opinions sought on each QI were 1) relevance to US veterans, 2) likelihood to improve gout care, and 3) ease of electronic capture. Participants were also asked to rank their top 3 gout QIs.

Results

Participating VA rheumatologists were mainly men, with a mean age of 51.3 years, and experienced in the management of gout. All 10 gout QIs were considered relevant, with a score of 8.2 or higher. The initiation of urate-lowering therapy, monitoring of urate levels after initiation of urate-lowering therapy, and treatment of acute gout with antiinflammatory agents scored the highest with regard to likelihood of improving gout care, with the first 2 QIs also thought to be the most relevant. Adjustment of initial allopurinol dosing in patients with renal impairment and in those receiving concurrent azathioprine/6-mercaptopurine were perceived as the QIs most amenable to electronic capture. The top-ranked QIs were initiation of urate-lowering therapy with frequent gout attacks, serum urate monitoring after initiation of urate-lowering therapy, and adjustment of initial allopurinol dose to renal function.

Conclusion

In a national survey of VA rheumatologists, most gout QIs were thought to be highly relevant. QIs related to initiation of urate-lowering therapy, serum urate monitoring, and initial dosing of allopurinol were ranked the most important for veterans with gout.

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