引入方案后，住院期间急性痛风的管理得到改善。

Improved management of acute gout during hospitalization following introduction of a protocol.

机构信息

South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia.

出版信息

Int J Rheum Dis. 2012 Dec;15(6):512-20. doi: 10.1111/j.1756-185X.2011.01642.x. Epub 2011 Jul 28.

DOI:10.1111/j.1756-185X.2011.01642.x

PMID:23253233

Abstract

AIM

To determine whether implementation of a protocol to manage in-hospital acute gout has improved the care of patients by non-rheumatologists.

METHOD

Two systematic case-file reviews were performed to determine the management of acute gout in all episodes occurring in hospitalized patients before (April 2005-December 2006) and after (November 2008-September 2009) introduction of a protocol for acute gout management in a tertiary referral hospital. The protocol targeted non-rheumatologists with primary intentions to continue baseline anti-gout medications on admission, prevent inappropriate prescriptions of colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) and allopurinol in the hospital, encourage invitations for assistance by rheumatology, and promote combination therapy in cases of severe gout.

RESULTS

Excluding patients under the primary care of a rheumatologist, 118 cases of acute gout occurring during hospitalization were reviewed before and 89 cases after introduction of the gout protocol. Post-protocol, there was a significant increase in continuation of baseline allopurinol (P = 0.01), significantly less inappropriate prescriptions of colchicine (P < 0.001) and allopurinol (P = 0.02), and a fall in the occurrence of overall adverse events (P = 0.01). After protocol introduction, when monotherapy was prescribed, NSAID usage declined and prednisone usage increased (P = 0.04), but there was no significant shift toward combination therapy use. Delays from symptom recognition to treatment were significantly reduced (P < 0.001), and rheumatology involvement significantly increased from 33.9% pre-protocol to 51.7% post-protocol.

CONCLUSION

Following introduction of a hospital-wide protocol for acute gout management, there have been significant improvements in the management of acute gout by non-rheumatologist clinicians.

摘要

目的

确定管理院内急性痛风的方案实施是否改善了非风湿病专家对患者的治疗。

方法

在一家三级转诊医院中，进行了两次系统性病历回顾，以确定在引入急性痛风管理方案（2008 年 11 月至 2009 年 9 月）前后，住院患者所有发作中急性痛风的管理情况。该方案的目标人群是非风湿病专家，主要目的是在入院时继续使用基线降尿酸药物，防止在医院中不恰当地开具秋水仙碱、非甾体抗炎药（NSAIDs）和别嘌醇，鼓励邀请风湿病专家协助，并在严重痛风病例中推广联合治疗。

结果

排除风湿病专家主要负责的患者后，在引入痛风方案前共回顾了 118 例住院期间急性痛风发作病例，在引入后回顾了 89 例。方案实施后，继续使用基线别嘌醇的比例显著增加（P = 0.01），不合理开具秋水仙碱（P < 0.001）和别嘌醇（P = 0.02）的情况明显减少，且总体不良事件的发生有所下降（P = 0.01）。方案引入后，当开具单一疗法时，非甾体抗炎药的使用减少，而泼尼松的使用增加（P = 0.04），但联合治疗的使用并未显著增加。从症状识别到治疗的延迟明显减少（P < 0.001），且风湿病专家的参与度从方案引入前的 33.9%显著增加到方案引入后的 51.7%。