L Fraenkel1, D T Felson. 1. Yale University, Department of Internal Medicine, Section of Rheumatology, PO Box 208031, 333 Cedar Street, New Haven, CT 06520-8031, USA. liana.fraenkel@med.va.gov
Abstract
OBJECTIVE: To examine rheumatologists' attitudes toward routine ophthalmologic screening for hydroxychloroquine (HCQ) retinopathy and to estimate the acceptability of hypothetical guidelines discouraging this practice. METHODS: We E-mailed a random sample of 300 US rheumatologists listed in the American College of Rheumatology (ACR) Directory who treat adults. We asked about current screening practice, reasons for screening, and the effect of hypothetical guidelines discouraging routine screening on future practice. Associations between adherence to guidelines and clinical variables were evaluated using multiple logistic regression. RESULTS: Of 56% who responded, almost all (94%) currently screen their patients at least once per year. Seventy-five percent stated that they would continue to screen because they are unwilling to accept any risk of visual loss among their patients; 74% would continue to screen because of legal liability; and 56% felt their patients would insist on being screened regardless of their physician's opinion. Forty-four percent stated that they would continue to screen regularly, even if the ACR published guidelines discouraging routine screening. Rheumatologists unwilling to accept any risk of retinopathy were less likely to follow guidelines discouraging screening (46 vs 77%, adjusted OR 0.2, 95% CI 0.1-0.6). Patient insistence and fear of legal liability were not significantly associated with predicted adherence to guidelines. CONCLUSION: Our survey indicates that the majority of rheumatologists currently routinely screen their patients for HCQ retinopathy, and that many would not follow ACR guidelines discouraging this practice, at least in part because they are unwilling to accept any risk of visual damage.
OBJECTIVE: To examine rheumatologists' attitudes toward routine ophthalmologic screening for hydroxychloroquine (HCQ) retinopathy and to estimate the acceptability of hypothetical guidelines discouraging this practice. METHODS: We E-mailed a random sample of 300 US rheumatologists listed in the American College of Rheumatology (ACR) Directory who treat adults. We asked about current screening practice, reasons for screening, and the effect of hypothetical guidelines discouraging routine screening on future practice. Associations between adherence to guidelines and clinical variables were evaluated using multiple logistic regression. RESULTS: Of 56% who responded, almost all (94%) currently screen their patients at least once per year. Seventy-five percent stated that they would continue to screen because they are unwilling to accept any risk of visual loss among their patients; 74% would continue to screen because of legal liability; and 56% felt their patients would insist on being screened regardless of their physician's opinion. Forty-four percent stated that they would continue to screen regularly, even if the ACR published guidelines discouraging routine screening. Rheumatologists unwilling to accept any risk of retinopathy were less likely to follow guidelines discouraging screening (46 vs 77%, adjusted OR 0.2, 95% CI 0.1-0.6). Patient insistence and fear of legal liability were not significantly associated with predicted adherence to guidelines. CONCLUSION: Our survey indicates that the majority of rheumatologists currently routinely screen their patients for HCQ retinopathy, and that many would not follow ACR guidelines discouraging this practice, at least in part because they are unwilling to accept any risk of visual damage.