Monitoring hydroxychloroquine dosages to avoid retinal toxicity in patients within the VA Healthcare System, a multi-site study
Through the SFVA Measurement Science QUERI led by Principle Investigator Gabriela Schmajuk MD, the Albuquerque VA Healthcare System was enrolled in a multi-site study to identify patients with hydroxychloroquine doses greater than the recommended 5mg/kg to reduce the risk of retinal toxicity.
Using the Dashboard tool, patients with hydroxychloroquine doses greater than 5mg/kg were identified. Data about these patients, including weight, rheumatologic diagnoses, dosages, and prescribing providers was collected. The prescribing providers were then contacted with dosage recommendations.
Results or expected outcome.
Twenty-eight patients were identified with Hydroxychloroquine dosages greater than 5mg/kg. It was expected that with recommendations, the prescribing providers would decrease the prescribed dosages of hydroxychloroquine to be in line with recommended guidelines to reduce risk of retinal toxicity. However, per recent Dashboard report, these changes have not yet been made.
At the time of this abstract, one month after dosage recommendations were given to prescribing providers, the outreach has not been effective at reducing the hydroxychloroquine dosages prescribed to the identified patients. There are several reasons for this. First, it may take time for these changes to take effect. It is also possible that the providers are waiting for follow-up appointments with their patients to change the doses. Second, hydroxychloroquine only comes in 200mg tablets. With most patients needing a dosage of approximately 300mg a day. This is difficult to dose with every other day dosing. Lastly, some referrals back to rheumatology have been made for patients identified within the study with prescriptions of hydroxychloroquine from their primary care provider. In time, we expect to see some improvement in results.
Keller, Meredith; David Cisneros; Kimberly Reiter; and Gabriela Schmajuk. "A provider-facing dashboard to monitor hydroxychloroquine dosing within the VA Healthcare System: the Albuquerque VA experience." (2021). https://digitalrepository.unm.edu/hsc_qips/63