3. Monitor sUA levels for all gout patients: Consistent tracking of gout patients’ sUA level at specific stages of their care ensures a standardized approach to optimal treatment, Dr. FitzGerald says. According to the eQCMs, if a patient with gout starts or changes urate-lowering therapy, then serum urate should be measured no later than six months after the change. For all patients with gout receiving urate-lowering therapy, serum urate should be measured at least once every 12 months.
4. Understand the value of patient education for optimal, uninterrupted urate-lowering treatment: In general, gout is a poorly managed condition for several reasons, Dr. FitzGerald says. One reason is that gout often gets triaged after other chronic health conditions, such as diabetes, hypercholesterolemia, cardiovascular disease or hypertension. A second reason: Optimal gout management is dependent on adherence to taking medications. But when gout symptoms are quiescent, a patient may choose to stop taking medications, not realizing they are hindering their treatment.3
“Taking time to speak with patients about the importance of taking the drugs supports patient buy-in,” he says. “Applying these quality measures in practice gives rheumatologists and colleagues, including nurses and pharmacists, a way to improve their performance in having these conversations with patients in a consistent way.”
5. Find a way to apply the measures: Of the 10 eCQMs developed by the ACR-supported group, four were endorsed by the ACR’s Quality Measures Subcommittee and two were endorsed by the National Quality Forum. Three measures—evaluating indications for urate-lowering therapy, monitoring serum urate and treat-to-target outcome—were incorporated into the ACR’s Rheumatology Informatics System for Effectiveness (RISE) registry.
“I’m a big fan of RISE because it gives physician practice groups a way to apply quality measures to evaluate their own performance,” Dr. FitzGerald says. He notes that having these data can lead to valuable quality improvement interventions.
Example: UCLA has applied these measures, which resulted in an established process in which a pharmacist within Dr. FitzGerald’s practice checks in with patients to determine that they are taking their gout medication and getting their sUA level checked.
“These measures address the important factors that can make the difference in reaching the outcomes we should all be helping our patients achieve,” Dr. FitzGerald says.
Carina Stanton is a freelance science writer in Denver.
References
- Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the U.S. general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011 Oct;63(10):3136–3141.
- FitzGerald JD, Mikuls TR, Neogi T, et al. Development of the American College of Rheumatology electronic clinical quality measures for gout. Arthritis Care Res (Hoboken). 2018 May;70(5):659–671.
- Aung T, Myung G, FitzGerald JD. Treatment approaches and adherence to urate-lowering therapy for patients with gout. Patient Prefer Adherence. 2017 Apr 19;11:795–800. eCollection 2017.
