Abstract
Purpose :
Hydroxychloroquine (HCQ) retinopathy is a major long-term side effect of HCQ, and risk of toxicity is decreased with appropriate dosing and timely screening. However, over half of patients on HCQ may not receive appropriate screening. We perform a retrospective chart review to determine whether hydroxychloroquine teleretinal screenings decrease time-to-appointment and time-in-clinic in a large public county safety net hospital setting.
Methods :
The study was approved by the USC Institutional Review Board. Patients with active HCQ prescription orders and most recent ophthalmology visit at LAC+USC from 11/1/2018 to 11/25/2019 were identified by an electronic medical record query (n=544). Patients who underwent teleretinal screening (n=207) were excluded from this list to identify a convenience sample of 54 patients who underwent regular clinic screening (n=380). Demographic characteristics, most recent weight, known risk factors, and dates for clinic visits, HCQ prescription orders, and ophthalmology eConsult requests were recorded. Time-to-appointment and time-in-clinic were compared between teleretinal screening and regular screening with Student’s t-test.
Results :
88.7% of the regular clinic screening (RCS) population, and 90.7% of the teleretinal screening (TRS) population was female. Indications for hydroxychloroquine included most commonly lupus (22% in the RCS group, and 38.5% in the TRS group) and rheumatoid arthritis (48.1% in the RCS group, 41.5% in the TRS group). Patients in TRS experienced a significantly decreased latency between eConsult request and a scheduled appointment for screening compared with for patients in RCS (3.19 months vs 5.28 months, p < 0.001). Average total time of appointment was also significantly different: 69 minutes for TRS compared to 180.4 min RCS (p=0.006).
Conclusions :
In our two patient cohorts who undergo teleretinal screening vs regular clinic screening, we demonstrate that teleretinal screening patients may benefit from decreased wait time from initial ophthalmology eConsult to appointment time, and decreased average total appointment time. These improvements may lead to improved resource utilization and management in a large public county safety net hospital setting.
This is a 2020 ARVO Annual Meeting abstract.