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Abstract：
BACKGROUND: With the prevalence of and hospitalizations for gout increasing, optimizing care for patients with gout is imperative. The 2012 American College of Rheumatology gout guidelines emphasize that timely monitoring is key to achieving serum urate (SUA) goals. Few studies have examined this metric following the 2012 update, and to our knowledge, none have examined a veteran population.
OBJECTIVE: To evaluate adherence to urate-lowering therapy (ULT) monitoring guidelines in a veteran population.
METHODS: This is a single-center, multisite, retrospective chart review of US veterans receiving ULT for gout within the VA (Veterans Affairs) Tennessee Valley Healthcare System from January 1, 2013, to June 30, 2015. The primary end point was percentage of patients with a SUA within 6 months of initial xanthine oxidase inhibitor prescription. Secondary end points included percentage of patients with SUA <6 mg/dL and percentage of patients with uptitration following SUA above goal.
RESULTS: A total of 601 patients met inclusion criteria for the study; after application of exclusion criteria, 505 were analyzed. Of these, 295 patients (58%) did not have a SUA drawn within 6 months, and 162 patients (32%) reached the end of the study period without SUA measured. Of 226 patients with SUA above goal on initial check, 64 (28%) had timely dose adjustment, whereas 143 patients (63%) had no adjustment. A total of 161 patients (32%) had a SUA at goal within the study period.
CONCLUSIONS: Rates of ULT monitoring at a major VA medical center were suboptimal, and improved adherence to guideline recommendations is needed.
OBJECTIVE: To evaluate adherence to urate-lowering therapy (ULT) monitoring guidelines in a veteran population.
METHODS: This is a single-center, multisite, retrospective chart review of US veterans receiving ULT for gout within the VA (Veterans Affairs) Tennessee Valley Healthcare System from January 1, 2013, to June 30, 2015. The primary end point was percentage of patients with a SUA within 6 months of initial xanthine oxidase inhibitor prescription. Secondary end points included percentage of patients with SUA <6 mg/dL and percentage of patients with uptitration following SUA above goal.
RESULTS: A total of 601 patients met inclusion criteria for the study; after application of exclusion criteria, 505 were analyzed. Of these, 295 patients (58%) did not have a SUA drawn within 6 months, and 162 patients (32%) reached the end of the study period without SUA measured. Of 226 patients with SUA above goal on initial check, 64 (28%) had timely dose adjustment, whereas 143 patients (63%) had no adjustment. A total of 161 patients (32%) had a SUA at goal within the study period.
CONCLUSIONS: Rates of ULT monitoring at a major VA medical center were suboptimal, and improved adherence to guideline recommendations is needed.
摘要：
背景：随着痛风的患病率和住院率的增加，优化痛风患者的护理势在必行。2012年美国风湿病学会痛风指南强调，及时监测是实现血清尿酸（SUA）目标的关键。在2012年的更新之后，很少有研究检查过这个指标，根据我们的知识，没有人检查过退伍军人。
目的：评估老年人群对尿酸降低治疗（ULT）监测指南的依从性。
方法：这是一个单中心，多站点，从2013年1月1日至2015年6月30日,在VA(退伍军人事务)田纳西谷医疗保健系统内接受痛风ULT的美国退伍军人的回顾性图表回顾.主要终点是初始黄嘌呤氧化酶抑制剂处方后6个月内SUA患者的百分比。次要终点包括SUA<6mg/dL的患者百分比和SUA高于目标后增加滴定的患者百分比。
结果：共601例患者符合本研究的纳入标准；应用排除标准后，505进行了分析。其中,295名患者（58%）在6个月内没有进行SUA抽取，162名患者(32%)在没有测量SUA的情况下达到研究期结束。在初步检查中，226名SUA高于目标的患者中，64（28%）有及时的剂量调整，而143例患者（63%）没有调整。在研究期间，共有161名患者（32％）的SUA达到目标。
结论：主要VA医疗中心的ULT监测率不理想，并且需要改进对指南建议的遵守。
目的：评估老年人群对尿酸降低治疗（ULT）监测指南的依从性。
方法：这是一个单中心，多站点，从2013年1月1日至2015年6月30日,在VA(退伍军人事务)田纳西谷医疗保健系统内接受痛风ULT的美国退伍军人的回顾性图表回顾.主要终点是初始黄嘌呤氧化酶抑制剂处方后6个月内SUA患者的百分比。次要终点包括SUA<6mg/dL的患者百分比和SUA高于目标后增加滴定的患者百分比。
结果：共601例患者符合本研究的纳入标准；应用排除标准后，505进行了分析。其中,295名患者（58%）在6个月内没有进行SUA抽取，162名患者(32%)在没有测量SUA的情况下达到研究期结束。在初步检查中，226名SUA高于目标的患者中，64（28%）有及时的剂量调整，而143例患者（63%）没有调整。在研究期间，共有161名患者（32％）的SUA达到目标。
结论：主要VA医疗中心的ULT监测率不理想，并且需要改进对指南建议的遵守。
