June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Electronic clinical decision support tool for hydroxychloroquine dosing guideline adherence
Author Affiliations & Notes
  • Rebecca Chen
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Blanche Kuo
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Aneesha Kalur
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
    Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Justin Muste
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
    Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Rishi P. Singh
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
    Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Rebecca Chen, None; Blanche Kuo, None; Aneesha Kalur, None; Justin Muste, None; Rishi Singh, None
  • Footnotes
    Support  This study was supported in part by the NIH-NEI P30 Core Grant (IP30EY025585), Unrestricted Grants from The Research to Prevent Blindness, Inc., and Cleveland Eye Bank Foundation awarded to the Cole Eye Institute.
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1720. doi:
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    • Get Citation

      Rebecca Chen, Blanche Kuo, Aneesha Kalur, Justin Muste, Rishi P. Singh; Electronic clinical decision support tool for hydroxychloroquine dosing guideline adherence. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1720.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To implement and assess the impact of an electronic clinical decision support tool (DST) on prescriber adherence to 2016 Academy of Ophthalmology (AAO) recommendations for a hydroxychloroquine maximum daily dose of 5 mg/kg actual body weight.

Methods : A DST was developed to trigger a pop-up alert within the electronic medical record when a prescriber orders hydroxychloroquine exceeding 5 mg/kg actual body weight or >400mg daily. The prescriber may choose to amend the prescription or override the alert. The tool was implemented on April 21, 2020. A chart review was performed of all hydroxychloroquine prescriptions in the 6-month post-intervention period (May – November 2020). Inclusion criteria were patient age ≥18 years; availability of dose and frequency; availability of actual body weight; and outpatient prescription status. Only the most recent prescription was used in cases of an individual patient having multiple prescriptions. Prevalence of excess hydroxychloroquine dosing (>5mg/kg/day) and mean daily dose in the post-intervention period was compared to previously collected, pre-intervention data from 2018 (under review for publication), using the chi-squared test and 2-sample t-test, respectively. The odds ratios of excessive dosing was assessed using multivariable logistic regression that included sex, race, weight, and prescriber specialty.

Results : There were 7915 patients with active hydroxychloroquine prescription, of which 7415 (94%) met inclusion criteria. There prevalence of excessive dosing decreased from 27.4% pre-DST to 21.1% post-DST (P<0.001). Mean daily dose decreased from 342±94 mg (4.3±1.4 mg/kg/day) pre-DST to 324±93mg (4.1±1.3mg/kg/day) post-DST (P<0.001). Only 0.2% prescriptions exceeded mean 400mg daily, and 0.1% prescriptions were indicated for COVID-19. In multivariable analysis, a rheumatologist prescriber (in comparison to all other specialties, OR 0.66 [99% CI 0.54-0.80]) and greater weight (OR 0.94 [99% CI 0.93-0.95], equivalent to -0.062 log odds per 1 kg increase in weight) were associated with reduced odds of excessive dosing.

Conclusions : Implementation of a DST significantly improved prescriber adherence with 2016 AAO ophthalmic safety recommendations for hydroxychloroquine dosing. As daily dosage is a strong predictor of retinopathy risk, an electronic DST demonstrates potential to reduce ophthalmic morbidity associated with chronic hydroxychloroquine use.

This is a 2021 ARVO Annual Meeting abstract.

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