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The Dispensing of NSAIDs in those with a Diagnosis of Gout

Basic Facts

Stage of development

Designed

Potential or current usage

This indicator is used by the Health Quality and Safety Commission for the New Zealand Atlas of Variation.

Brief overview of the measure

General description

Broad subject area: Gout Specific aspect of care: Dispensing of NSAIDs Population of interest: People with a diagnosis of gout, aged 20-79 years, who were dispensed non-steroidal anti-inflammatory drugs Setting: health services Level of focus: District Health Boards

Rationale for selection

NSAIDs are usually the first line of treatment for acute gout flares. This indicator may reflect the number of people experiencing acute gout flares who are not on long-term preventive therapy for gout. International best practice indicates that people experiencing one or more, or frequent (two or more) acute gout flares per year should be offered long-term urate-lowering therapy.) Although NSAIDs are effective at treating acute gout flares, these medicines have important side effects including kidney injury and peptic ulcer disease.

Type of measure

Outcomes

Domain(s) of quality

Equity and access

Application and interpretation of the measure

Stated intent of the measure

The aim of this measure is to compare numbers of those with a diagnosis of gout who are dispensed NSAIDs between various District Health Boards in New Zealand. It can be used for quality improvement and benchmarking purposes regarding treatment of gout.

Caveats - Considerations

General points: • Data is not presented where the number of people was less than 10. This is to preserve confidentiality. • People were assigned to their district health board (DHB) of domicile; where more than one domicile was recorded, the most recent value was selected. • Ethnicity data was analysed by prioritised ethnic group (Māori, Pacific peoples, Asian, European/other). For people reporting multiple ethnic groups, the most recent value was selected. The rates for the Asian population were similar to the European/other group, aand in some DHBs the Asian population was small, so it was decided to combine these groups into non- Māori/non-Pacific. Data where ethnicity was not specified was excluded from ethnicity analysis, meaning the sum of ethnicity data does not equal the total. Exclusions: • The date of dispensing is after the date of death, OR • The patient category is either J or Y (juvenile or youth). NSAIDs included were: celecoxib, diclofenac sodium, diflunisal, fenbufen, fenoprofen calcium, flurbiprofen, ibuprofen, indomethacin, ketoprofen, mefenamic acid, meloxicam, naproxen, naproxen sodium, phenylbutazone, piroxicam tenoxicam, tiaprofenic acid, rofecoxib and sulindac.

Links to other measures

New Zealand Atlas of Variation

Level of health care delivery/setting

Any health setting

Target population

Individuals aged 20-79 years with indications of gout and no diagnosis of leukaemia or lymphoma who are in touch with health services.

Calculation of the measure

Output of calculation

Data are presented as standard deviation from the mean. Standard deviation is a statistical measure of variation from a mean. Assuming that recorded instances are normally distributed (i.e. they are in the usual ‘bell-shaped curve’) 95% of all recorded instances would be expected to be within 2 standard deviations either side of the mean. The two ‘middle’ shades will be within one standard deviation of the mean.

Numerator description

People with a diagnosis of gout, aged 20-79 years, who were dispensed non-steroidal anti-inflammatory drugs in the year 1 July 2010-30 June 2011.

Denominator description

Those aged between 20-79 years with an indication of gout in the HealthTracker (discharge diagnosis of gout (ICD 9 274, ICD 10 M 10) from a public hospital from 1988-to 30 June 2011 or who have been dispensed allopurinol or colchinine from a community pharmacy between 2001-2011) and excluding patients with a diagnosis of luekaemia or lymphoma (ICD 10 C81-C96)

Time period

One year

Criteria/standard for optimal performance

There are no criteria for optimal performance; this measure is intended to benchmark regional differences in prevalence of persons with gout.

Data source

The data is extracted from Health Tracker and the Ministry of Health.

Method of extraction

No information available.

Appraisal of the measure

Availability of evidence to support application of the measure

The measure has been developed or endorsed by an organization that promotes rigorous development and use of clinical performance measures (at an international, national, regional or local level).

Evidence of feasibility and reliability of implementation

Availability of data - Required data elements for the measure can be gathered during routine practice activities

Development approach

The subjects in the Atlas were chosen by a group of clinical experts and consumers based on clear criteria regarding the importance of the area and the likelihood there was unexplained variation in services.

Other items

Links to educational activities

Owner details

Reference number

4302

Date of entry to library

2013-10-22 15:31:34

Owner (Organisation name)

Health Quality and Safety Commission

Owner (Email contact)

Richard.Hamblin@hqsc.govt.nz

Creator (Organisation name)

Health Quality and Safety Commission

Creator (Email contact)

Richard.Hamblin@hqsc.govt.nz