Implementation of a Best Practice Advisory to Improve Screening for Hydroxychloroquine Retinal Toxicity

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : Hydroxychloroquine (HCQ), a common treatment for autoimmune diseases, is associated with retinal toxicity. To limit the risk of retinopathy, national guidelines recommend a maximum dose of < 5 mg/kg/day, a baseline eye exam, and annual screening starting 5 years after initiating HCQ. The purpose of this study is to improve adherence to screening guidelines with a Best Practice Advisory (BPA) alert in electronic medical records at the University of Virginia (UVA).

Methods : A survey of 1590 adult patients who were prescribed HCQ at UVA from 1/1/21-1/1/22 was conducted to assess eye examination history. A BPA alert was designed to trigger when a HCQ order is placed for patients who have not had an eye exam or ophthalmology referral order placed within the past 12 months. The BPA was released to a single UVA Dermatology attending on 5/10/23 for a trial period, and data were extracted to determine utilization. A retrospective chart review was performed to determine rates of HCQ prescription and ophthalmology referrals before and after BPA roll out. A differences in differences regression comparing ophthalmology referrals for patients prescribed HCQ by dermatology versus rheumatology providers was computed to determine statistical significance assuming parallel trends.

Results : Of the 1590 patients prescribed HCQ from 1/1/21-1/1/22, 18% and 29% had been examined at UVA Ophthalmology over the previous 1 and 5 years, respectively. 533 (34%) patients responded to the survey and, of these, 87% and 94% reported having had an eye exam within the last 1 and 5 years, respectively. From 11/22/23-11/22/24, the BPA fired 82 times during 75 encounters, resulting in 54 ophthalmology referrals. An additional 16 referrals were placed during these encounters, resulting in 93% of patients receiving an ophthalmology referral. Comparing prescribing and referral patterns over a 1-year period before and after BPA implementation for rheumatology (R, no BPA exposure) and dermatology (D, single attending with BPA exposure) providers, ophthalmology referrals increased by 18% following BPA implementation (D: 20 to 37%; R: 18% to 18%; p = 0.01).

Conclusions : Baseline adherence to screening guidelines is high based on patient surveys with most patients receiving screenings outside of UVA. Ophthalmology referral rates for patients prescribed HCQ increased following implementation of the BPA alert.

Volume

66

Issue

8

First Page

6060

Comments

Association for Research in Vision and Ophthalmology ARVO Annual Meeting, May 4-8, 2025, Salt Lake City, UT

Last Page

6060

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