Nguyen Amy D, Lind Kimberly E, Day Richard O, Ross Daniel, Raban Magdalena Z, Georgiou Andrew, Westbrook Johanna I
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia.
Rheumatol Adv Pract. 2022 Nov 28;6(3):rkac091. doi: 10.1093/rap/rkac091. eCollection 2022.
Gout, a common form of arthritis, can be controlled successfully with pharmacotherapy and is 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.
Electronic health record data linked with aged care clinical notes and electronic medication administration information (11 548 residents in 68 residential aged care facilities, >65 years of age) were interrogated to identify people with gout, other chronic conditions and gout medication use. The outcomes examined were the proportion receiving urate-lowering therapy (ULT; preventative medication) and/or colchicine/non-steroidal anti-inflammatory drug (NSAID) (to treat gout flares), the number of ULT and colchicine/NSAID treatment episodes (periods of continuous days of medication use) and the duration of these treatment episodes.
The cohort included 1179 residents with gout, of whom 62% used a ULT, with a 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.
Nearly one-third of residents with gout did not receive ULT. In those receiving ULT, recurrent short courses were common. Overall, management of gout in aged care residents appears to be suboptimal, largely owing to intermittent and short exposure to ULT, and with female residents at greater risk of poor gout management.
痛风是一种常见的关节炎形式，通过药物治疗可成功控制，因此是检验慢性病管理的理想模型。我们的目的是根据适用于澳大利亚老年护理机构的痛风一般管理指南，检查痛风的治疗情况。
对与老年护理临床记录和电子用药管理信息相关联的电子健康记录数据（68家老年护理机构中11548名年龄大于65岁的居民）进行查询，以识别痛风患者、其他慢性病患者及痛风用药情况。所检查的结果包括接受降尿酸治疗（ULT；预防性药物）和/或秋水仙碱/非甾体抗炎药（NSAID）（用于治疗痛风发作）的比例、ULT及秋水仙碱/NSAID治疗疗程数（连续用药天数）以及这些治疗疗程的持续时间。
该队列包括1179名痛风患者，其中62%使用ULT，使用次数中位数为1次，持续时间很短[中位数 = 4天，总使用次数（即重复使用）中位数 = 52天]。在痛风患者中，9%还使用秋水仙碱或NSAID。女性居民接受ULT的可能性较小，且疗程较短。
近三分之一的痛风患者未接受ULT。在接受ULT的患者中，反复进行短疗程治疗很常见。总体而言，老年护理机构中痛风的管理似乎并不理想，主要原因是ULT的使用断断续续且时间较短，女性居民痛风管理不善的风险更高。
