Adherence to Hydroxychloroquine Dosing Guidelines by Rheumatologists
Ophthalmology, May 2017
Braslow et al. examined rheumatologists’ adherence to the hydroxychloroquine (HCQ) dosing guidelines published by the American Academy of Ophthalmology in 2011 and revised in 2016. They performed a review of records at a single integrated health care entity (NorthShore, Glenview, Ill.) and found that about half of the patients on HCQ were prescribed higher doses than those recommended in the guidelines.
The researchers used electronic medical records (EMR) to identify all patients in the system who had an order for HCQ between 2009 and 2016 and who had been evaluated by a NorthShore staff ophthalmologist during that time period (N = 554). Of these, 92 patients had been started on HCQ before publication of the 2011 guidelines, and 462 were started after. Recommended maximum starting doses were calculated using 2 formulas based on either ideal body weight (per 2011 guidelines) or actual weight (per 2016 guidelines). The main outcome measure was the percentage of patients whose dose exceeded the recommended maximum.
The researchers found that approximately half of the patients had been placed on initial doses in excess of 2011 guideline recommendations, and there was no significant difference in percentages between those started before and after the guidelines were issued (54.3% and 49.4%, respectively; p = .381). Further, on the basis of the 2016 dosing guidelines, 56% of patients currently on HCQ continue to receive higher- than-recommended doses.
The researchers concluded that the published ophthalmology screening guidelines have had no appreciable impact on rheumatologists’ prescribing patterns, as approximately half of all patients started on HCQ at NorthShore received doses above the recommended maximum, and more than half of all patients currently on treatment are receiving excessive doses. Such deficiencies in patient care pose substantial medicolegal risk. The researchers recommend instituting EMR-based alerts and dosing algorithms, which can be easily instituted and applied systemwide without creating added costs or requiring significant ophthalmology resources.
The original article can be found here.