Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: American Academy of Ophthalmology (AAO) 2011 guidelines recommend that patients receiving hydroxychloroquine (HCQ) or chloroquine (CQ) undergo regular screening for retinal toxicity with 1 of 3 objective tests (spectral domain macula ocular CT (SD-mOCT), fundus autofluorescence (FAF), or multi-focal electroretinogram (mf-ERG)), which are sensitive for early retinal damage. In this study, we examined adherence to AAO guidelines for retinal toxicity screening in patients seen in ophthalmology clinics within a single health system who were users of HCQ or CQ.
Methods: We performed a system-wide electronic medical record (EMR) query to identify all patients seen in ophthalmology clinic between June 2012 – June 2014 who had mention of HCQ or CQ in the clinical note associated with the encounter (n=523). A chart review was performed on a random sample of these patients (n=294) to identify active users of HCQ or CQ or patients undergoing a baseline ophthalmology exam prior to starting these medications (denominator population) and to confirm performance of SD-mOCT, mfERG and/or FAF (numerator). We also examined use of 10-2 Acute Visual Fields (AVF), the previous standard of care for antimalarial toxicity screening. Finally, we determined whether the newly recommended tests could be reliably identified through automated EMR queries since this would increase the efficiency of future quality improvement efforts.
Results: 208 patients in our sample were active users of HCQ/CQ or receiving a baseline ophthalmology exam prior to starting HCQ/CQ at the time of their ophthalmology encounter (denominator). 57.2% (n=119) had the recommended screening test performed over the study period (119 had SD-mOCT, 22 had FAF, and 7 had mf-ERG). An additional 4.3% (n=9) received only AVF screening. The automated EMR query accurately and reliably identified all 119 patients who had received the recommended objective screening. Chart review was used to determine the reasons why 42.8% (89) patients did not undergo the recommended screening tests (Table).
Table: Reasons for Not Undergoing Objective Screening for Antimalarial Retinal Toxicity
|
Reason for Not Undergoing Objective Screening |
Frequency |
|
No mention of any objective screening procedure in ophthalmology note |
43.8% (n=39) |
|
Appropriate objective screening procedure ordered but not performed |
33.7% (n=30) |
|
Documented in ophthalmology note that the patient is also followed by an outside ophthalmologist |
11.2% (n=10) |
|
Appropriate objective screening procedure mentioned but neither ordered nor performed |
7.8% (n=7) |
|
Testing was deferred because the patient planned on using HCQ/CQ for a short period of time |
3.4% (n=3) |
Conclusion: We found that only 57.2% of patients who were active users of HCQ or CQ underwent objective screening tests recommended by the AAO 2011 guidelines, suggesting a significant gap in quality of care. Structured query retrieval of this information was highly reliable, which will increase the efficiency of identifying care gaps for patients using these medications in future quality improvement projects.
To cite this abstract in AMA style:
Haserodt S, Tonner C, Murray SG, Schmajuk G, Yazdany J. Adherence to 2011 American Academy of Ophthalmology Guidelines to Perform Objective Screening Tests for Detection of Antimalarial Retinal Toxicity Is Suboptimal [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/adherence-to-2011-american-academy-of-ophthalmology-guidelines-to-perform-objective-screening-tests-for-detection-of-antimalarial-retinal-toxicity-is-suboptimal/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-2011-american-academy-of-ophthalmology-guidelines-to-perform-objective-screening-tests-for-detection-of-antimalarial-retinal-toxicity-is-suboptimal/