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

Abstract

Background: Urate Lowering Therapies (ULTs), mainly Xanthine Oxydase Inhibitors, are widely used by general practitioners (GPs) in asymptomatic hyperuricaemia, although no guideline currently recommends doing so. The use of ULTs in asymptomatic hyperuricaemia has been associated with an increased risk of ULTs-related adverse drug reactions. Aim:Our study aimed at exploring GPs' views and practices in relation to the prescription or non-prescription of ULT in asymptomatic hyperuricaemia. Methods:We 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. Results:We identified two behaviours 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 pre-existing 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. Conclusions:Our results support several strategies of ULTs de-prescribing in asymptomatic hyperuricaemia: the promotion of de-prescribing of serum acid uric laboratory test in daily practice (a), supporting the clinical reasoning in the case of asymptomatic hyperuricaemia detection (b) but also during ULTs renewals (c) leading to a prioritisation of the safest prescriptions (d) through shared medical decision (e).Additional studies are necessary to further develop and evaluate these de-prescribing strategies.