Gout is a chronic form of inflammatory arthritis that is characterized by elevated levels of serum urate. Individuals with acute gout can experience sudden flares of severe pain in the affected joints. If gout is left untreated, chronic gout can develop, and individuals may experience recurrent gout flares. Without urate-lowering therapies (ULTs), deposits of monosodium urate crystals can permanently damage and deform joints.
Gout is relatively common among residents in residential aged-care facilities (RACFs), as advanced age is a risk factor for gout. Additionally, comorbidities are common in the elderly. The medications required to manage comorbid conditions can result in polypharmacy, which increases the likelihood of deleterious drug interactions.
“Given that most residents in RACFs receive their medications under supervision of caregivers and nurses, greater adherence to prescribed treatments compared with older adults in the community who are more likely to self-manage their medications would be expected,” researchers from the Australian Institute of Health Innovation wrote in their study. Published in Rheumatology Advances in Practice, the researchers investigated how gout management in RACFs aligns with the current recommendations.
Specifically, researchers examined the use of ULT and medications for gout flares in the gout cohort identified, with respect to resident length of stay (LOS), age, sex, and comorbidities. Conducting a retrospective cohort study, electronic health record data from 68 RACFs were collected. In total, 11,528 residents with gout were included in the final analysis. The outcome measurements were the proportion of patients receiving ULT and/or colchicine and non-steroidal anti-inflammatory drug (NSAIDs), the period of continuous days of medication use, and the duration of these treatment episodes.
Of the total study population, 1179 residents had a diagnosis of gout. The most common comorbidities in this cohort were hypertension, dementia, and diabetes. Gout management guidelines recommend that if a patient has had >2 gout flares, they ought to initiate ULT. Of RACF residents with gout, only 9.25% received ULT during their stay. Male residents with gout tended to be on ULT for a greater proportion of their stay in RACFs compared with female residents with gout.
“This study showed that gout, a condition which has notoriously poor medication adherence in the community, also has suboptimal management within the RACF setting,” the researchers wrote. They went on to state that many residents with gout were either not receiving preventative ULTs or were receiving them in discordant ways.
Researchers concluded by arguing that “the electronic systems used by RACFs can be used to improve gout management in RACFs, for example by prompting prescribers to treat gout according to guidelines, such as through flagging residents with gout where ULTs are indicated and through reminders that if ULTs are indicated, they should not be stopped.”