Pharmacist-managed titration of urate-lowering therapy to streamline gout management.
Pharmacist-managed titration of urate-lowering therapy to streamline gout management.
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由药剂师管理的降尿酸治疗滴定，以简化痛风治疗。
DOI：
10.1007/s00296-019-04333-5
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发表时间：
2019
影响因子：
4
通讯作者：
Bays,AlisonM
中科院分区：
文献类型：
--
作者：
Huang,IrvinJ;Liew,JeanW;Morcos,MeredithB;Zuo,Silu;Crawford,Carol;Bays,AlisonM
根据2012年美国风湿病学会（ACR）指南，血清尿酸达标治疗是痛风管理的推荐模式。由于存在障碍，包括药物负担、经济困难和缺乏医学知识，患者很难坚持降尿酸盐治疗。我们的目的是在复杂的患者人群中创建一个由药剂师管理的转诊，用于滴定尿酸以达到目标血清尿酸（sUA）水平。我们利用临床数据库查询12个月内在风湿病诊所就诊的ICD-10诊断为痛风的患者。转诊标准是根据2012年ACR指南进行直肠癌根治术的适应症。要求由主治医师、研究员和医师助理组成的流变学提供者将确定的患者转介给药剂师管理的滴定计划。干预组由19名转诊患者组成，对照组由28名非转诊患者组成。转诊时，干预组的基线sUA（中位数（IQR））为8.8（2）mg/dL，对照组为7.6（2.8）mg/dL（p= 0.2）。研究结束时，干预组的sUA为6.1（1.4）mg/dL，对照组为6.8（3.2）mg/dL（p= 0.08）。在研究期结束时，19个干预组中的6个（32%）和28个对照组中的7个（25%）达到目标（p= 0.3）。一个新制定的药剂师管理的滴定计划，能够实现较低的平均sUA水平在转介患者相比，人口统计学上类似的个人谁接受标准痛风管理。
The treat-to-target approach for serum uric acid is the recommended model in gout management according to the 2012 American College of Rheumatology (ACR) guidelines. Adherence to urate-lowering therapy (ULT) can be difficult for patients due to barriers, which include medication burden, financial hardship, and lack of medical literacy. Our aim was to create a pharmacist-managed referral for the titration of ULT to target serum uric acid (sUA) levels in a complex patient population. We utilized a clinical database to query patients seen at a rheumatology clinic over a 12-month period with an ICD-10 diagnosis for gout. The referral criteria were indications for ULT per the 2012 ACR guidelines. Rheumatology providers, consisting of attendings, fellows, and a physician assistant, were asked to refer the identified patients to the pharmacist-managed titration program. The intervention group consisted of 19 referred patients and the control group consisted of 28 non-referred patients. The baseline sUA (median (IQR)) at the time of referral was 8.8 (2) mg/dL for the intervention group and 7.6 (2.8) mg/dL for the control group (p= 0.2). At the end of the study period, the sUA was 6.1 (1.4) mg/dL for the intervention group and 6.8 (3.2) mg/dL for the control group (p= 0.08). At the end of the study period, 6 of 19 (32%) intervention group and 7 of 28 (25%) control group were at goal (p= 0.3). A newly instituted pharmacist-managed titration program was able to achieve lower average sUA levels in referred patients compared to demographically similar individuals who received standard gout management.