Healthcare Utilization Patterns Among Patients Presenting to Emergency Department for Gout Flares in Ontario, Canada: A Population-Based Retrospective Observational Study

Objectives Although gout can typically be effectively managed in outpatient settings, high rates of emergency department (ED) use may indicate potential gaps in ambulatory chronic disease management. To inform targeted improvements in gout healthcare delivery, we assessed annual ED visits for gout and identified patient characteristics and health services patterns that may be contributing to ED presentations. Methods We performed a population-based retrospective study, identifying the annual number of gout ED visits occurring between 2014 to 2023 in Ontario. Annual total and incident ED gout visits and rates were determined, then stratified by sex and age. We described clinical and sociodemographic characteristics and assessed patient-level health care usage factors both preceding and after the gout ED visit. Repeat ED presentations and hospitalizations were determined within 90-days. Among individuals aged ≥66 years, we further assessed dispensations for flare abortive medications, urate lowering therapy and opioids within a 30-day window. Results The mean age of individuals presenting to ED was 59.7 (SD 16.4), and 77.5% were male. Between 2014–2023, there were 125,505 gout ED visits in Ontario, including 86,824 incident visits. Annual ED gout encounters peaked in 2018 (14,017 encounters) translating to an annual crude rate of 0.99 (95% CI 0.97–1.01) and male stratified annual rate of 1.56 (95% CI 1.53–1.59) visits per 1000-persons (Figure 1). Older adults had the highest ED visit rates at 3.01 (95% CI 2.89–3.15) visits per 1000-persons in 2015. Patients were highly comorbid with 55.5% of patients with ≥10 Aggregated Diagnosis Groups. Common comorbidities included hypertension (57.7%) and diabetes (24.0%). By 30-days post-ED encounter, 28.3% and 21.3% patients were dispensed a flare abortive medication or attended an ambulatory gout visit respectively, while 10.3% were dispensed an opioid. By 6 months, 38.1% of patients had serum urate testing. By 90-days, 29.9% of encounters led to ED re-presentation, with 9.4% of total encounters representing specifically for gout, culminating in 6.2% (1.5% for gout) of total encounters leading to hospital admission. Findings were comparable for incident ED gout visits. Conclusion In what is one of the first Canadian population-based assessments of acute care use for gout, our work suggests that there is a large burden of ED visits, with suboptimal post-ED health services use, marred by under-prescribing of flare medications, over-prescribing of opioids and high acute care representation rates. Quality improvement efforts should be directed at strategies to prevent upstream ED presentations for gout and enhancing appropriate follow-up care. Best Abstract On Quality Care Initiatives In Rheumatology Award