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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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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.
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.
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.
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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