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Montgomery A, Tarasovsky G, Izadi Z, Shiboski S, Whooley MA, Dana J, Ehiorobo I, Barton J, Bennett L, Chung L, Reiter K, Wahl E, Subash M, Schmajuk G. An Electronic Dashboard to Improve Dosing of Hydroxychloroquine Within the Veterans Health Care System: Time Series Analysis. JMIR Med Inform 2023; 11:e44455. [PMID: 37171858 PMCID: PMC10221491 DOI: 10.2196/44455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Hydroxychloroquine (HCQ) is commonly used for patients with autoimmune conditions. Long-term use of HCQ can cause retinal toxicity, but this risk can be reduced if high doses are avoided. OBJECTIVE We developed and piloted an electronic health record-based dashboard to improve the safe prescribing of HCQ within the Veterans Health Administration (VHA). We observed pilot facilities over a 1-year period to determine whether they were able to improve the proportion of patients receiving inappropriate doses of HCQ. METHODS Patients receiving HCQ were identified from the VHA corporate data warehouse. Using PowerBI (Microsoft Corp), we constructed a dashboard to display patient identifiers and the most recent HCQ dose and weight (flagged if ≥5.2 mg/kg/day). Six VHA pilot facilities were enlisted to test the dashboard and invited to participate in monthly webinars. We performed an interrupted time series analysis using synthetic controls to assess changes in the proportion of patients receiving HCQ ≥5.2 mg/kg/day between October 2020 and November 2021. RESULTS At the start of the study period, we identified 18,525 total users of HCQ nationwide at 128 facilities in the VHA, including 1365 patients at the 6 pilot facilities. Nationwide, at baseline, 19.8% (3671/18,525) of patients were receiving high doses of HCQ. We observed significant improvements in the proportion of HCQ prescribed at doses ≥5.2 mg/kg/day among pilot facilities after the dashboard was deployed (-0.06; 95% CI -0.08 to -0.04). The difference in the postintervention linear trend for pilot versus synthetic controls was also significant (-0.06; 95% CI -0.08 to -0.05). CONCLUSIONS The use of an electronic health record-based dashboard reduced the proportion of patients receiving higher than recommended doses of HCQ and significantly improved performance at 6 VHA facilities. National roll-out of the dashboard will enable further improvements in the safe prescribing of HCQ.
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Affiliation(s)
- Anna Montgomery
- San Francisco VA Medical Center, San Francisco, CA, United States
| | - Gary Tarasovsky
- San Francisco VA Medical Center, San Francisco, CA, United States
- University of California San Francisco, San Francisco, CA, United States
| | - Zara Izadi
- University of California San Francisco, San Francisco, CA, United States
| | - Stephen Shiboski
- University of California San Francisco, San Francisco, CA, United States
| | - Mary A Whooley
- San Francisco VA Medical Center, San Francisco, CA, United States
- University of California San Francisco, San Francisco, CA, United States
- UCSF Philip R Lee Institute for Health Policy Studies, San Francisco, CA, United States
| | - Jo Dana
- San Francisco VA Medical Center, San Francisco, CA, United States
| | - Iziegbe Ehiorobo
- University of California San Francisco, San Francisco, CA, United States
| | | | - Lori Bennett
- Ralph H Johnson VA Medical Center, Charleston, SC, United States
| | - Lorinda Chung
- Palo Alto VA Medical Center, Palo Alto, CA, United States
- Stanford University, Palo Alto, CA, United States
| | - Kimberly Reiter
- Raymond G Murphy VA Medical Center, Albuquerque, AZ, United States
- University of New Mexico School of Medicine, Albuquerque, AZ, United States
| | - Elizabeth Wahl
- Seattle/Puget Sound VA Healthcare System, Seattle, WA, United States
| | - Meera Subash
- UT Physicians Center for Autoimmunity, Houston, TX, United States
| | - Gabriela Schmajuk
- San Francisco VA Medical Center, San Francisco, CA, United States
- University of California San Francisco, San Francisco, CA, United States
- UCSF Philip R Lee Institute for Health Policy Studies, San Francisco, CA, United States
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Morgan MA, Dana J, Loewenstein G, Zinberg S, Schulkin J. Interactions of doctors with the pharmaceutical industry. J Med Ethics 2006; 32:559-63. [PMID: 17012493 PMCID: PMC2563313 DOI: 10.1136/jme.2005.014480] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 12/21/2005] [Accepted: 01/05/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To assess the opinions and practice patterns of obstetrician-gynaecologists on acceptance and use of free drug samples and other incentive items from pharmaceutical representatives. METHODS A questionnaire was mailed in March 2003 to 397 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network. RESULTS The response rate was 55%. Most respondents thought it proper to accept drug samples (92%), an informational lunch (77%), an anatomical model (75%) or a well-paid consultantship (53%) from pharmaceutical representatives. A third (33%) of the respondents thought that their own decision to prescribe a drug would probably be influenced by accepting drug samples. Respondents were more likely to think the average doctor's prescribing would be influenced by acceptance of the items than theirs would be (p<0.002). Respondents who distributed drug samples to patients indicated doing so because of patients' financial need (94%) and for their convenience (76%) and less so as a result of knowledge of the efficacy of the sample product (63%). A third (34%) of respondents agreed that interactions with industry should be more strictly regulated. CONCLUSION Obstetrician-gynaecologists largely indicated that they would act in accordance with what they think is proper regarding accepting incentive items from pharmaceutical representatives. Although accepting free drug samples was considered to be appropriate more often than any other item, samples were most commonly judged to be influential on prescribing practices. The widely accepted practice of receiving and distributing free drug samples needs to be examined more carefully.
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Affiliation(s)
- M A Morgan
- Research Department, American College of Obstetricians and Gynecologists, 409 12th Street, SW, Washington, DC 20024, USA.
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