Gabriela Santiago Pichardo1_, MD, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Emily Gutowski1_, MD, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Weiwei Chi2, MD, Department of Rheumatology, Icahn School of Medicine at Mount Sinai, New York, New York.
Background
Hydroxychloroquine (HCQ) is often used to treat rheumatologic diseases including lupus and rheumatoid arthritis, but can lead to irreversible retinopathy in approximately 7% of patients after 5 years of use. Our aim is to improve the annual ophthalmology screenings in patients seen in our rheumatology clinic on HCQ by 90% over 3 months with a patient-centered approach using medication reminder cards.
Methods
We started a patient-centered initiative involving reminder cards placed in the waiting room of the faculty and fellows’ clinic. Each card contains information about retinopathy screening and an area for patients to track their yearly ophthalmology visits. We conducted a chart review of all patients on HCQ who had had an office or telehealth visit at the rheumatology clinic during the \ three months prior to the start of the intervention to establish baseline rates of ophthalmology referrals and/or ophthalmology visits, then compared this to the rates following the implementation of our intervention. We also sent pre- and post- intervention surveys to the providers at the rheumatology clinic to gauge awareness of the intervention and to assess for any potential inconveniences.
Results
35.5% (196/552) had been referred to ophthalmology by any provider during the 3 months prior to the start of the introduction of the medication cards (August,2021- October 2021). Of all patients, 16.1% (89/552) actually received an ophthalmology exam over the prior 3 months. Post-intervention, 48.7% (247/507) were referred to ophthalmology during the three months (November 1, 2021-January 28, 2022). Of these patients, 22.1% (112/507) actually received an ophthalmology exam over the intervention period. Screening referral rates increased by 13.2% and eye exam rates increased by 6% following the intervention. Post intervention survey sent to providers show an increase in referrals by 25%.
Conclusions
There was improvement in annual ophthalmology screenings referrals in the intervention period. Our data was limited by only analyzing a three month period, patient participation, provider documentation, and lack of outside medical records. Further interventions include creating posters to accompany reminder cards, expanding the location of reminder cards to providers’ rooms, and translating both posters and cards into Spanish.

Improving the eye screening of patients on Hydroxychloroquine using medication cards

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