FRI0225 Electronic consultation utility in the management of gout
Authors: J. Chang, M. DiFiore, M. Wong
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Gout is the most prevalent inflammatory arthritis in adults worldwide. Although it can be managed by primary care physicians (PCPs), complex cases often require rheumatology consultation. The average wait time for an initial rheumatology clinic visit varies from 38 days to 47 weeks after diagnosis. Utilising electronic consults (E-consults) allows for a swift two-way communication between referring and rheumatology physicians (pre-consult exchange). Rheumatologists can then triage patients to electronic management versus face-to-face rheumatological evaluation to provide timely insight to improve patient care. <h3>Objectives</h3> To analyse the effectiveness of gout management via E-consult compared to PCP or rheumatology management at the Veteran's Affairs Medical Centre in Long Beach (VALB), CA, USA. <h3>Methods</h3> A retrospective study of 171 VALB gout patients from 2009 to 2014 was constructed. Patients were placed into groups based on modes of management: PCP (n=48), direct rheumatology (n=67), or E-consult management (n=56). Electronic medical records were reviewed for a 24 month period from the first gout flare or E-consult date. The read-out for management effectiveness included change in frequency of gout flares, related emergency department (ED) and PCP visits, renal function (creatinine clearance, CrCl), and serum uric acid levels (sUA). <h3>Results</h3> Of the 56 E-consults, 43 cases were resolved electronically and 13 were converted to face-to-face rheumatology visits. The wait time for recommendations from E-consults was 2.1±4.6 days, and face-to-face rheumatology visits was 22.9±20.1 days after pre-consult exchange, vs 43.1±56.9 days for direct rheumatology consults. Both E-consult and rheumatology clinic patients had more gout attacks and related ED visits at baseline (p=0.08). They were also more likely to be treated with allopurinol, colchicine, febuxostat and corticosteroids than with NSAIDs alone (p<i>&lt;</i>0.05). The number of gout attacks, and hence related PCP and ED visits, were significantly reduced when patients were managed by either a rheumatologist clinically or E-consult compared to PCP alone (p<i>&lt;</i>0.05), with significant decrease in sUA and improved CrCl (p<i>&lt;</i>0.001). Efficacy of E-consult management was comparable to rheumatology visits in the first 12 months, but at 18 months, direct rheumatology management superseded E-consults. <h3>Conclusions</h3> Gout management can be optimised when patients with uncontrolled disease are referred to rheumatology or E-consults within the first 12 months of active disease, and be transitioned to PCP management thereafter if disease is stable. E-consult serves as a reasonable alternative in managing gout with a shorter wait time for recommendations and rheumatology appointments. E- consults are an efficient means to address straight-forward clinical questions from PCPs, to expedite referrals to the rheumatology clinic. <h3>References</h3> [1] Zhang W, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR 1.Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1312–24. [2] Widdifield Jet al. Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data. CMAJ Open. 2016;4(2):E205–12. <h3>Disclosure of Interest:</h3> None declared