The Effect of an Electronic Medical Record Intervention on Hydroxychloroquine Prescribing Habits and Surveyed Providers’ Opinions of the 2016 American Academy of Ophthalmology Guidelines in the Rheumatology and Dermatology Practices of an Academic Institution

Abstract

Background Retinal toxicity is a rare adverse event related to the use of hydroxychloroquine (HCQ). To address this, in 2016, the American Academy of Ophthalmology (AAO) issued guidelines recommending that HCQ not exceed 5 mg/kg/day. We analyzed HCQ prescribing habits at our institution, compared to these guidelines, and used surveys to determine the opinions on these guidelines. We then introduced, in a prospective and non-controlled study, an electronic medical record (EMR) tool to study how this intervention might affect compliance with or opinions on these guidelines. Methods Data were collected pre-intervention (June 2017 - January 2019) and post-intervention (March 2019 - April 2020). In January 2019 we released our EMR tool. Results were analyzed using descriptive statistics for demographic data and Fisher’s exact tests for comparisons of proportions between groups. Results Pre-intervention, we reviewed 1,128 rheumatology charts and 282 dermatology charts. 31.0% and 39.7% respectively (32.8% combined) were prescribed HCQ > 5 .0 mg/kg/day. Post-intervention, we reviewed 1,158 rheumatology charts and 106 dermatology charts. 23.1% and 26.4% respectively (23.3% combined) were prescribed HCQ > 5.0 mg/kg/day. Post-intervention, fewer patients (9.5%) were prescribed HCQ > 5 mg/kg/day (p < 0.00001). Pre-intervention, we compiled 18 rheumatology surveys and 12 dermatology surveys. Post-intervention, we compiled 16 rheumatology surveys and 12 dermatology surveys. Post-intervention, fewer rheumatologists incorrectly described the AAO weight-based guidelines. Combined, there was an overall reduction but not of statistical significance (p = 0.47). Conclusions At our academic institution, there remains unfamiliarity of and hesitation to comply with the 2016 AAO guidelines. Prescribed doses often exceed what is recommended in these guidelines. An EMR tool can improve compliance with these guidelines and might improve providers’ familiarity with these guidelines.