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Only one-third of patients who visited the ED for a gout flare had gout-related outpatient follow-up within 6 months, highlighting care gaps and opioid overuse.

Just a third of patients who sought care in the emergency department (ED) for a gout flare had a follow-up outpatient visit addressing gout in the subsequent 6 months, according to a study published in JCR: Journal of Clinical Rheumatology.

“Because utilization of acute care services for gout is associated with substantially higher costs compared with routine outpatient gout management, our findings that few patients are seeking outpatient follow-up underscore the critical need to understand and mitigate ED utilization for gout flare,” wrote corresponding author Maria I. Danila, MD, MSc, MSPH, and colleagues.

The retrospective cohort study included 159 patients with gout flares between September 2021 and August 2022 at a US academic medical center that spans 3 EDs and an urban urgent care center. Researchers investigated the types and rates of outpatient follow-up after an urgent/emergent care for a gout flare.

Among patients in the study, 75.5% were men and 71.1% were Black or African American. Mean Area Deprivation Index and Social Vulnerability Index scores reflected high deprivation and social vulnerability.

“A total of 85 patients (53.5%) with a gout flare followed up with an outpatient provider in our health care system, but only 56 individuals (35.2%) had an outpatient visit addressing gout within 6 months of their ED visit,” the researchers reported.

According to the study, factors associated with a higher probability of outpatient gout follow-up included being married (OR, 2.66), having no comorbidities (OR, 3.86), using colchicine at the ED visit or discharge (OR, 2.67), and being older (OR, 1.44). Area deprivation and social vulnerability were not associated with gout follow-up.

“Contrary to our expectations,” researchers wrote, “in our study, people with greater comorbidity burden were less likely to follow up for gout.”

At ED discharge, 56% of patients were prescribed opioids, 42% were prescribed nonsteroidal anti-inflammatory agents, and just one-third were prescribed colchicine, the study found. In multivariable analysis, receiving an opioid prescription was associated with 2.3-fold increased odds of a repeat ED visit within 6 months.

“Improving the coordination of care from acute to outpatient settings may help mitigate some of the barriers to appropriate anti-inflammatory medication use and urate-lowering therapy for gout, reduce repeat ED visits, and moderate opioid prescription use,” researchers wrote.