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Uric acid lowering therapy: prescribing patterns in a large cohort of older adults
  1. Daniel H Solomon (dhsolomon{at}partners.org)
  1. Brigham and Women's Hospital, United States
    1. Jerry Avorn (javorn{at}partners.org)
    1. Brigham and Women's Hospital, United States
      1. Raisa Levin (rlevin{at}partners.org)
      1. Brigham and Women's Hospital, United States
        1. M Alan Brookhart (mabrookhart{at}partners.org)
        1. Brigham and Women's Hospital, United States

          Abstract

          Background: Uric acid lowering therapy (UALT) is considered a chronic treatment for gout. Relatively little is known about adherence to UALT.

          Methods: We assessed adherence with UALT over a one year study period among 9,823 older adults enrolled in a pharmacy benefit program. Two adherence measures were calculated, the percent of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC < 80% was considered poor adherence and its predictors were examined in multivariable logistic models.

          Results: The average PDC was 54% (SD 36%) with 64% of patients considered poorly compliant over the study period. Fifty-six percent had experienced an extended break in UALT. Predictors of poor adherence included younger age (OR 1.50, 95% CI 1.33 – 1.69 for ages 65-74 compared with 85 and above) and black race (OR 1.86, 95% CI 1.52 – 2.27 compared with white race). Most patients (93%) received their initial UALT prescription from a non-specialist and this also predicted poor adherence (OR 1.15, 95% CI 0.96 – 1.38 compared with rheumatologists or nephrologists).

          Conclusion: Adherence with UALT is poor. While uric acid levels were not measured in this study, poor adherence with UALT is likely to reduce attainment of goal uric acid levels.

          • adherence
          • allopurinol
          • compliance
          • gout
          • uric acid

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