背景:视网膜毒性是与使用羟氯喹(HCQ)有关的罕见不良事件。为了解决这个问题,2016年,美国眼科学会(AAO)发布指南,建议HCQ不超过5mg/kg/天.我们分析了我们机构的HCQ处方习惯,与这些准则相比,并使用调查来确定对这些指南的意见。然后我们介绍,在一项前瞻性和非对照研究中,将临床决策支持(CDS)工具纳入电子病历(EMR),以研究这种干预措施可能如何影响这些指南的依从性或对这些指南的意见.
方法:收集干预前(2017年6月至2019年1月)和干预后(2019年3月至2020年4月)的数据。2019年1月,我们发布了CDS工具。使用人口统计学数据的描述性统计和组间比例比较的Fisher精确检验对结果进行分析。
结果:干预前,我们查阅了1128份风湿病图和282份皮肤科图。分别为31.0%和39.7%(合并32.8%)的HCQ>5.0mg/kg/天。干预后,我们查阅了1161份风湿病图和110份皮肤科图。分别为23.0和25.5%(23.2%组合)的HCQ>5.0mg/kg/天。干预后,服用HCQ>5mg/kg/天的患者减少9.6%(P<.001)。干预前,我们编制了18项风湿病调查和12项皮肤病学调查。干预后,我们编制了16项风湿病调查和12项皮肤病学调查。干预后,更少的风湿病学家错误地描述了AAO基于体重的指南.合并,总体减少,但无统计学意义(P=0.47).大多数接受调查的提供商认为CDS工具是有用的(72.2%)。
结论:在我们的学术机构,对于遵守2016年AAO指南仍然不熟悉和犹豫.处方剂量通常超过这些指南中的推荐剂量。CDS工具可以提高对这些指南的依从性,并可能提高提供者对这些指南的熟悉度。
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, a clinical decision support (CDS) tool into the electronic medical record (EMR) to study how this intervention might affect adherence 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 CDS 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 1128 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 1161 rheumatology charts and 110 dermatology charts. 23.0 and 25.5% respectively (23.2% combined) were prescribed HCQ > 5.0 mg/kg/day. Post-intervention, 9.6% fewer patients were prescribed HCQ > 5 mg/kg/day (P < .001). 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 = .47). The majority of providers surveyed believed that the CDS tool was useful (72.2%).
CONCLUSIONS: At our academic institution, there remains unfamiliarity with and hesitation to comply with the 2016 AAO guidelines. Prescribed doses often exceed what is recommended in these
guidelines. A CDS tool can improve adherence with these guidelines and might improve providers\' familiarity with these
guidelines.