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)
Authors: 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.
