Dataset Information

Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines.

ABSTRACT: Hydroxychloroquine (HCQ) retinopathy may be more common than previously recognized; recent ophthalmology guidelines have revised recommendations from ideal body weight (IBW)-based dosing to actual body weight (ABW)-based dosing. However, contemporary HCQ prescribing trends in the UK remain unknown.We examined a UK general population database to investigate HCQ dosing between 2007 and 2016. We studied trends of excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW) and determined their independent predictors using multivariable logistic regression analyses.Among 20,933 new HCQ users (78% female), the proportions of initial HCQ excess dosing declined from 40% to 36% using IBW and 38% to 30% using ABW, between 2007 and 2016. Among these, 47% of women were excess-dosed (multivariable OR 12.52; 95% CI 10.99-14.26) using IBW and 38% (multivariable OR 1.98; 95% CI,1.81-2.15) using ABW. Applying IBW, 37% of normal and 44% of obese patients were excess-dosed; however, applying ABW, 53% of normal and 10% of obese patients were excess-dosed (multivariable ORs?=?1.61 and 0.1 (reference?=?normal); both p?

SUBMITTER: Jorge AM

PROVIDER: S-EPMC6034317 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines.

Jorge April M AM Melles Ronald B RB Zhang Yuqing Y Lu Na N Rai Sharan K SK Young Lucy H LH Costenbader Karen H KH Ramsey-Goldman Rosalind R Lim S Sam SS Esdaile John M JM Clarke Ann E AE Urowitz M B MB Askanase Anca A Aranow Cynthia C Petri Michelle M Choi Hyon H

Arthritis research & therapy 20180705 1

<h4>Background</h4>Hydroxychloroquine (HCQ) retinopathy may be more common than previously recognized; recent ophthalmology guidelines have revised recommendations from ideal body weight (IBW)-based dosing to actual body weight (ABW)-based dosing. However, contemporary HCQ prescribing trends in the UK remain unknown.<h4>Methods</h4>We examined a UK general population database to investigate HCQ dosing between 2007 and 2016. We studied trends of excess HCQ dosing per ophthalmology guidelines (def ...[more]

PMID: 29976231

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Project description:Changes in consumer behavior are forcing companies to rapidly shift their distribution channels toward an omnichannel model. In the case of the ophthalmology sector, however, the purchase of contact lenses and prescription glasses requires professional examination by a trained eye specialist. This peculiarity of the sector affects the shift toward omnichannel. This paper is novel in that it addresses a research gap by studying the distribution channels for regulated products and services such as health products that required a closer professional service. This paper addresses the transformation of companies toward an omnichannel model using a common scientific forecasting method (i.e., the Delphi method) to identify trends and problems. In this scenario of high complexity and uncertainty where there is insufficient relevant quantitative information for decision making, the Delphi method is applied to ensure a consensual decision-making process. Consensus was reached by a panel of 11 experts on the Spanish ophthalmology sector after three rounds of questioning. The final set of indicators involve 19 different criteria grouped into four categories (1) current situation of the distribution channel, (2) changes in distribution channels, (3) trends and near future of the distribution channel, and (4) consequences and adaptations for supply chain agents. The results from each round of consultation were then analyzed by means of statistical analysis with SPSS and discussed for each category. The results confirm that traditional intermediaries face difficulties to avoid being squeezed out of the sector because of shortening distribution channels and the entry of new online intermediaries with service integration models. We identify future scenarios and define actions that different agents can take to enhance their competitiveness in the short and long term. The arrival of omnichannel distribution is inevitable in the ophthalmology sector, entailing a major transformation from a rigid traditional distribution model to a more complex and flexible model following the entry of new online intermediaries.

Project description:BackgroundRetinal 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.MethodsData 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.ResultsPre-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%).ConclusionsAt 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.

Dataset Information

Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines.

Publications

Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines.

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