Evaluation of Physician Adherence to Gout and Hyperuricemia Management in the UK

Title: Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD)
Mikuls TR, et al.
Publication: Rheumatology (Oxford). 2005 Aug;44(8):1038-42. Epub 2005 May 3.

In prescribing allopurinol, a class of gout drugs that inhibit the activity of xanthine oxidase enzyme, there are 3 quality indicators of prescribing practices. These quality indicators were developed to assess:

1. Dosages in patients with kidney impairments
2. Simultaneous use with azathioprine (an immunosuppressant) or 6-mercaptopurine (a chemotherapy medicine)
3. Use in treatment of hyperuricaemia (or hyperuricemia) with no symptoms

The authors examined the statistical relationships of the sociodemographic aspects, comorbidity or presence of other diseases, follow-up duration, use of multiple medications simultaneously, of 63,105 gout patients.

The authors found that the following number of patients were eligible for the various quality indicators:

Quality Indicator 1
185 (0.3%)
Quality Indicator 2
52 (0.1%)
Quality Indicator 3
471 (0.75%)

In practice, the deviation for the three individual quality indicators ranged from 25% to 57%.

Inappropriate treatments for hyperuricemia with no symptoms seem to be increased by the following factors: male gender, older age, history of chronic kidney failure, and simultaneous use of multiple drugs.

High blood pressure or hypertension and diuretic use (use of medicines that increase the production of urine) lower the odds of mistreatment.

In conclusion, the author noted that approximately 25% to 50% of patients that were eligible for at least one of the quality care indicator were subject to possible allopurinol prescription error. They suggested that more effort is required to reduce the possibility of inappropriate use of allopurinol, especially in high-risk groups of older men and those receiving multiple medications.

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