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Rheumatology Advance Access published online on May 3, 2005
Rheumatology, doi:10.1093/rheumatology/keh679
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received November 23, 2004
Accepted April 4, 2005

Original Papers

Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD)

T. R. Mikuls 1, J. T. Farrar 2, W. B. Bilker 2, S. Fernandes 2, and K. G. Saag 3*

1 Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Omaha VA Medical Center, Omaha, NE, USA
2 Center for Clinical Epidemiology and Biostatistics and Center for Education and Research in Therapeutics (CERT), University of Pennsylvania, Philadelphia, PA, USA
3 Department of Medicine, Birmingham, AL, USA; Center for Education and Research in Therapeutics (CERT) in Musculoskeletal Disorders, University of Alabama at Birmingham, Birmingham, AL, USA

* To whom correspondence should be addressed.
K. G. Saag, E-mail: ksaag{at}uab.edu


  Abstract

Objectives: To examine adherence to validated quality indicators assessing the quality of allopurinol use in the treatment of gout and asymptomatic hyperuricaemia.

Methods. We determined physician adherence in the UK General Practice Research Database (GPRD) to three validated quality indicators developed to assess the quality of allopurinol prescribing practices. These indicators were developed to assess: (i) dosing in renal impairment; (ii) concomitant use with azathioprine or 6-mercaptopurine; and (iii) use in the treatment of asymptomatic hyperuricaemia. We also examined the association of patient-level factors (sociodemographics, comorbidity, follow-up duration and concomitant medicine use) with the treatment of asymptomatic hyperuricaemia using multivariable logistic regression.

Results. Of the 63 105 gout patients, 185 (0.3%) were eligible for Quality Indicator 1 and 52 (0.1%) were eligible for Quality Indicator 2. There were an additional 471 patients with asymptomatic hyperuricaemia eligible for Quality Indicator 3. Rates of practice deviation for the three individual quality indicators ranged from 25 to 57%. Male sex, older age, a history of chronic renal failure, and a greater number of concomitant medications were significantly associated with increased odds of inappropriate treatment for asymptomatic hyperuricaemia. Hypertension and diuretic use were associated with lower odds of this practice.

Conclusions. One-quarter to one-half of all patients eligible for at least one of the validated quality of care indicators were subject to possible allopurinol prescribing error, suggesting that inappropriate prescribing practices are widespread with this agent. Future interventions aimed at reducing inappropriate allopurinol use are needed and should be targeted towards high-risk groups, including older men and those receiving multiple concomitant medications.

Keywords: Gout; Allopurinol; Quality of care; GPRD; Medical error; Asymptomatic hyperuricaemia; Quality indicator.
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