Prescription of Allopurinol – Cross-Sectional Survey
Prescription of Allopurinol – Cross-Sectional Surveygerman translation / full article
Background: In Germany allopurinol is a frequently used drug against gout. Recent studies showed deviations between international recommendations and therapeutic strategies of family practitioners regarding the management of acute and chronic gout. This project investigates the background of allopurinol prescription and usage by answering the following questions:
1. What is the prevalence of allopurinol-intake in a primary care setting?
2. Why do patients take allopurinol? (rationales of patients´- and physicians´ point of view)?
Methods: This cross-sectional study was performed in family practices in the state of Hessia, Germany. The prevalence was defined as the percentage of patients prescribed allopurinol related to the total amount of patients during six months. Using semi-structured questionnaires patients and their family practitioners were interviewed about allopurinol medication. The interview data was analysed quantitatively.
Results: On average, 2.1 % (CI 1.6–2.8). of all patients in the seven participating practices were taking allopurinol. In total 89 patients were recruited (mean age 68 years, 78 % male). In 80 % of the cases allopurinol was initially prescribed by the family practitioner. An acute gout attack represented the most frequent indication ( 70 %). In one third of the symptomatic patients (31 %) this occurrence remained a single acute attack. In 39% of patients the last gout attack occurred over five years ago. According to the family practitioners an asymptomatic hyperuricemia lead in 23 % to allopurinol treatment. Half of the patients (51 %) reported an allopurinol intake for more than five years. An allopurinol withdrawal in the past was documented in about 9 % of the cases. Polypharmacy with more than four agents was noted in 65 % of patients.
Conclusions: Results of this study should encourage family practitioners in re-evaluating the next allopurinol prescription critically. In many cases, according to the current guidelines of the German College of General Practitioners and Family Physicians (DEGAM), there is room for reducing allopurinol (especially important in patients undergoing polypharmacy).