title: Modifiable factors associated with allopurinol adherence and outcomes among patients with gout in an integrated healthcare system.
abstract: OBJECTIVE
  To identify modifiable patient and provider factors associated with allopurinol adherence and the achievement of a serum urate acid (SUA) goal in gout.
  
  
  METHODS
  We identified a retrospective cohort of patients with gout, newly treated with allopurinol. All patient data came from administrative datasets at a large integrated health delivery system. Patients were ≥ 18 years old at time of initial allopurinol dispensing, and had 12 months or more of membership and drug eligibility prior to the index date. Allopurinol adherence was defined as a proportion of days covered ≥ 0.80, evaluated during the first 12 months of observation after the initial dispensing. Multivariable logistic regression was used to examine factors associated with allopurinol nonadherence and attaining an SUA concentration < 6.0 mg/dl.
  
  
  RESULTS
  We identified 13,341 patients with gout with incident allopurinol use (mean age 60 yrs, 78% men). Of these, 9581 patients (72%) had SUA measured both at baseline and during followup. Only 3078 patients (32%) attained an SUA target of < 6.0 mg/dl during followup. Potentially modifiable factors associated with treatment adherence and obtaining the SUA goal in the multivariable analysis included concomitant diuretic use, prescriber specialty, and allopurinol dosing practices. Adherent patients were 2.5-fold more likely than nonadherent patients to achieve an SUA < 6.0 mg/dl during observation.
  
  
  CONCLUSIONS
  Among patients with gout initiating allopurinol in our study, 68% did not reach the SUA goal and 57% of patients were nonadherent. Modifiable factors, including allopurinol dose escalation, treatment adherence, rheumatology referral, and concomitant medication use, could be important factors to consider in efforts aimed at optimizing gout treatment outcomes.
authors.affiliation: From the Drug Information Services, Kaiser Permanente Southern California Region, Downey; Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; University of Nebraska Medical Center, and the Division of Rheumatology, Omaha VA, Omaha, Nebraska; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.N. Rashid, PharmD, MS, Research Scientist, Drug Information Services, Kaiser Permanente; B.W. Coburn, BS, University of Nebraska Medical Center; Y-L. Wu, MS; T.C. Cheetham, PharmD, MS, Department of Research and Evaluation, Kaiser Permanente; J.R. Curtis, MD, MS, MPH; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; T.R. Mikuls, MD, MSPH, Division of Rheumatology, Omaha VA and University of Nebraska Medical Center. Nazia.X.Rashid@kp.org.
authors.forename: Nazia
authors.initials: N
authors.lastname: Rashid
authors.affiliation: From the Drug Information Services, Kaiser Permanente Southern California Region, Downey; Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; University of Nebraska Medical Center, and the Division of Rheumatology, Omaha VA, Omaha, Nebraska; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.N. Rashid, PharmD, MS, Research Scientist, Drug Information Services, Kaiser Permanente; B.W. Coburn, BS, University of Nebraska Medical Center; Y-L. Wu, MS; T.C. Cheetham, PharmD, MS, Department of Research and Evaluation, Kaiser Permanente; J.R. Curtis, MD, MS, MPH; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; T.R. Mikuls, MD, MSPH, Division of Rheumatology, Omaha VA and University of Nebraska Medical Center.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Coburn
authors.affiliation: From the Drug Information Services, Kaiser Permanente Southern California Region, Downey; Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; University of Nebraska Medical Center, and the Division of Rheumatology, Omaha VA, Omaha, Nebraska; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.N. Rashid, PharmD, MS, Research Scientist, Drug Information Services, Kaiser Permanente; B.W. Coburn, BS, University of Nebraska Medical Center; Y-L. Wu, MS; T.C. Cheetham, PharmD, MS, Department of Research and Evaluation, Kaiser Permanente; J.R. Curtis, MD, MS, MPH; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; T.R. Mikuls, MD, MSPH, Division of Rheumatology, Omaha VA and University of Nebraska Medical Center.
authors.forename: Yi-Lin
authors.initials: YL
authors.lastname: Wu
authors.affiliation: From the Drug Information Services, Kaiser Permanente Southern California Region, Downey; Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; University of Nebraska Medical Center, and the Division of Rheumatology, Omaha VA, Omaha, Nebraska; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.N. Rashid, PharmD, MS, Research Scientist, Drug Information Services, Kaiser Permanente; B.W. Coburn, BS, University of Nebraska Medical Center; Y-L. Wu, MS; T.C. Cheetham, PharmD, MS, Department of Research and Evaluation, Kaiser Permanente; J.R. Curtis, MD, MS, MPH; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; T.R. Mikuls, MD, MSPH, Division of Rheumatology, Omaha VA and University of Nebraska Medical Center.
authors.forename: T Craig
authors.initials: TC
authors.lastname: Cheetham
authors.affiliation: From the Drug Information Services, Kaiser Permanente Southern California Region, Downey; Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; University of Nebraska Medical Center, and the Division of Rheumatology, Omaha VA, Omaha, Nebraska; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.N. Rashid, PharmD, MS, Research Scientist, Drug Information Services, Kaiser Permanente; B.W. Coburn, BS, University of Nebraska Medical Center; Y-L. Wu, MS; T.C. Cheetham, PharmD, MS, Department of Research and Evaluation, Kaiser Permanente; J.R. Curtis, MD, MS, MPH; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; T.R. Mikuls, MD, MSPH, Division of Rheumatology, Omaha VA and University of Nebraska Medical Center.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: From the Drug Information Services, Kaiser Permanente Southern California Region, Downey; Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; University of Nebraska Medical Center, and the Division of Rheumatology, Omaha VA, Omaha, Nebraska; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.N. Rashid, PharmD, MS, Research Scientist, Drug Information Services, Kaiser Permanente; B.W. Coburn, BS, University of Nebraska Medical Center; Y-L. Wu, MS; T.C. Cheetham, PharmD, MS, Department of Research and Evaluation, Kaiser Permanente; J.R. Curtis, MD, MS, MPH; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; T.R. Mikuls, MD, MSPH, Division of Rheumatology, Omaha VA and University of Nebraska Medical Center.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
authors.affiliation: From the Drug Information Services, Kaiser Permanente Southern California Region, Downey; Department of Research and Evaluation, Kaiser Permanente, Pasadena, California; University of Nebraska Medical Center, and the Division of Rheumatology, Omaha VA, Omaha, Nebraska; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.N. Rashid, PharmD, MS, Research Scientist, Drug Information Services, Kaiser Permanente; B.W. Coburn, BS, University of Nebraska Medical Center; Y-L. Wu, MS; T.C. Cheetham, PharmD, MS, Department of Research and Evaluation, Kaiser Permanente; J.R. Curtis, MD, MS, MPH; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; T.R. Mikuls, MD, MSPH, Division of Rheumatology, Omaha VA and University of Nebraska Medical Center.
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use*; D016208:Databases, Factual; D019033:Delivery of Health Care, Integrated; D005260:Female; D006073:Gout / Q000097:blood / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol
keywords: ADHERENCE; ALLOPURINOL; GOUT; INCIDENT