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S.R. Shareef, C. Wood, A.E. Kolker; Contraindicated Prescription Drug Use in Anatomically Narrow Angle Patients and Diagnosis Impact on Subsequent Physician Prescribing Using an Electronic Health Record (EHR) System . Invest. Ophthalmol. Vis. Sci. 2005;46(13):144.
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Purpose: Using EHR, to assess prevalence of contraindicated prescription drug use in patients diagnosed with anatomically narrow angles (NA) at risk for angle closure, and its impact on physician prescribing during follow up. Methods: Newly diagnosed NA patients with or without glaucoma were identified using EHR from September 2002 to September 2004. Records of those undergoing laser iridotomy (Group A; n=50) or observation (Group B; n=33) after initial diagnosis were reviewed for prescription meds with warnings for 'glaucoma', 'narrow' or 'closed' angle glaucoma. In Group B, physician prescribing was assessed by identifying active drugs prior to the intial eye visit. The last encounter > 6 months after the eye exam was reviewed and all actively prescribed drugs recorded. For data analysis, percent of patients with contra–indicated drug use was estimated with a binomial proportion and 95% confidence interval. Results: 16 (32%, 95% CI= [20%, 47%]) in Group A (n=50) had contra–indicated drug use at presentation vs. 11 (33%, 95% CI= [17%, 49%]) in Group B (n=33). Majority had narrow angles without glaucoma [32(64%) Group A; 29(88%) Group B]. Vasodilators and Benzodiazepines were most frequently prescribed (26% and 24% respectively) of all contra–indicated drugs. During follow–up >6 months, 14 (42%, 95% CI= [25%, 61%]) continued to actively use such drugs. Conclusions: (1) Patients with NA at risk for angle closure undergoing either laser or observation, one–third initially took prescription drugs with warnings for 'glaucoma', 'narrow' or 'closed' angle glaucoma reflecting futility of such labels in those unaware of their diagnosis. (2) Eye physicians must become familiar with different classes of drugs that pose a potential risk in those with susceptible NA. (3) Increased contra–indicated drug prescribing in Group B despite EHR documentation warrants need for better communication between eye care providers with other medical specialties to request alternative drugs when feasible. (4) Or, despite awareness, physicians may prescribe drugs due to medical necessity. If so, ophthalmologists need to monitor these patients during treatment.
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