Zell S C, Carmichael J M
Department of Internal Medicine, Veterans Administration Medical Center, Reno, NV 89520.
Am J Hosp Pharm. 1989 Sep;46(9):1813-6.
The use of long-term allopurinol therapy in patients with gout was evaluated. A pharmacy computer printout was used to identify all outpatients for whom allopurinol had been prescribed during a six-month period in 1985 at a large Veterans Administration medical center. Medical records were reviewed to (1) classify patients as either having or not having definite indications for allopurinol treatment, (2) determine whether physicians had ordered roentgenographic and laboratory tests for presence of monosodium urate crystals, uric acid excretion, and renal function, and (3) identify gout-associated risk factors and disease entities that could cause hyperuricemia. A pharmacy record of all allopurinol and probenecid prescriptions for the six-month period was obtained, along with cost data. Of the 286 patients who received allopurinol, 32 received the drug for an indication that could not definitely be established as gout. Of the 254 remaining patients, only 45 (17.7%) had a definite indication for allopurinol use as defined by the pharmacy and therapeutics committee. Although pretreatment measurement of serum creatinine was common, only a few patients underwent joint aspiration, a 24-hour urine collection, or roentgenography of affected joints. Large proportions of the patients were found to have gout-associated risk factors. If the 209 patients without definite indications for allopurinol therapy had been treated with probenecid instead of allopurinol, the annual cost savings would have been about $3700. Most of the patients receiving allopurinol for gout could reasonably have been treated with a uricosuric agent such as probenecid at a lower cost. Generally, physicians did not use diagnostic tests optimally before prescribing allopurinol and did not attempt to modify risk factors for gout.
对痛风患者使用长期别嘌醇治疗进行了评估。利用药房计算机打印记录来识别在1985年的六个月期间于一家大型退伍军人管理局医疗中心开具过别嘌醇处方的所有门诊患者。查阅医疗记录以：(1) 将患者分类为有或没有别嘌醇治疗的明确指征；(2) 确定医生是否已安排进行X线检查和实验室检测以查看尿酸钠结晶的存在情况、尿酸排泄及肾功能；(3) 识别可能导致高尿酸血症的痛风相关危险因素和疾病实体。获取了该六个月期间所有别嘌醇和丙磺舒处方的药房记录以及费用数据。在接受别嘌醇治疗的286名患者中，32名患者接受该药的指征无法明确确定为痛风。在其余254名患者中，只有45名(17.7%)有药房和治疗学委员会定义的别嘌醇使用的明确指征。虽然血清肌酐的治疗前测量很常见，但只有少数患者接受了关节穿刺、24小时尿液收集或受累关节的X线检查。发现很大比例的患者有痛风相关危险因素。如果对209名没有别嘌醇治疗明确指征的患者使用丙磺舒而非别嘌醇进行治疗，每年可节省费用约3700美元。大多数因痛风接受别嘌醇治疗的患者本可以合理地使用诸如丙磺舒等促尿酸排泄药以更低成本进行治疗。一般而言，医生在开具别嘌醇之前并未最佳地使用诊断检测，也未尝试改变痛风的危险因素。
