Factors influencing Urate Lowering Therapies prescription for asymptomatic hyperuricemia by general practitioners: a qualitative study

Autor: Stéphane Munck, Hubert Maisonneuve, Jean-Pascal Fournier, Emilie Tourzel
Přispěvatelé: Risques, Epidémiologie, Territoire, INformations, Education et Santé (RETINES), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Département de médecine générale [Université de Nantes - UFR de Médecine et des Techniques Médicales], Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Collège Universitaire de Médecine Générale [Lyon] (CUMG), Université de Lyon
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Asymptomatic hyperuricemia
Urate lowering therapies
[SDV]Life Sciences [q-bio]
qualitative study
Renewal
Inappropriate Prescribing
030204 cardiovascular system & hematology
Prescription
0302 clinical medicine
Promotion (rank)
Influencing factors
030212 general & internal medicine
Hyperuricemia
Practice Patterns
Physicians'
Qualitative Research
media_common
general practice
General Medicine
Middle Aged
urate lowering therapies
3. Good health
Female
medicine.symptom
Thematic analysis
Family Practice
General practice
Adult
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
media_common.quotation_subject
Audit
asymptomatic hyperuricemia
influencing factors
Asymptomatic
03 medical and health sciences
General Practitioners
medicine
Humans
xanthine oxidase inhibitors
Xanthine oxidase inhibitors
Medical prescription
ddc:613
renewal
prescription
business.industry
nutritional and metabolic diseases
Guideline
medicine.disease
Uric Acid
Family medicine
Qualitative study
business
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Qualitative research
Zdroj: International Journal of Clinical Practice, Vol. 73, No 9 (2019) P. e13383
International Journal of Clinical Practice
International Journal of Clinical Practice, Wiley, 2019, 73 (9), pp.1-11. ⟨10.1111/ijcp.13383⟩
ISSN: 1368-5031
1742-1241
DOI: 10.1111/ijcp.13383⟩
Popis: International audience; BackgroundUrate Lowering Therapies (ULTs), mainly Xanthine Oxydase Inhibitors, are widely used by general practitioners (GPs) in asymptomatic hyperuricemia, although no guideline currently recommends to do so. The use of ULTs in asymptomatic hyperuricemia has been associated with an increased risk of ULTs-related adverse drug reactions.AimOur study aimed at exploring GPs’ views and practices in relation to the prescription or non-prescription of ULT in asymptomatic hyperuricemia.MethodsWe conducted a qualitative study using individual semi-structured interviews with 14 French GPs. We built a purposeful sample searching for maximum variation on 8 GPs' personal and professional criteria such as age, years of installation, location of their practice. We conducted a thematic analysis of the transcripts, following Miles and Huberman three steps model: data reduction, data presentation, conclusion drawing and verifications.ResultsWe identified two behaviors leading to inappropriate prescription of ULTs among interviewed GPs. Primary prescribers frequently used uric acid serum levels and had a positive representation of ULTs. Other GPs behaved in an ambivalent way: they did not initiate ULTs, but systematically renewed preexisting prescriptions. They had a negative perception of ULTs but considered them unimportant during drug reassessment. De-prescribing occurred mainly because of external input such as the need to lighten the prescription or the participation in an audit in general practice.ConclusionsOur results support several strategies of ULTs de-prescribing in asymptomatic hyperuricemia: the promotion of de-prescribing of serum acid uric lab test in daily practice (a), supporting the clinical reasoning in the case of asymptomatic hyperuricemia detection (b) but also during ULTs renewals (c) leading to a prioritization of the safest prescriptions (d) through shared medical decision (e). Additional studies are necessary to further develop and evaluate these de-prescribing strategies.
Databáze: OpenAIRE
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