Category: Federal Forum Posters
Purpose: Conjunctivitis is often the most common cause of red eye and one of the leading reasons that ophthalmic antibiotics are prescribed. However, most cases of viral and bacterial conjunctivitis are self-limiting and do not require pharmacologic intervention. Antibiotic-corticosteroid combination ophthalmic products (COPs) may be overprescribed in the primary care setting in cases of acute conjunctivitis. The objectives of this medication use evaluation (MUE) were to determine if the cohort of patients with or without a diagnosis of acute conjunctivitis who were prescribed COPs had an indication for their use, appropriate screening and follow-up in the Veterans Health Administration (VHA).
Methods: Through a database evaluation, a cohort of patients receiving prescriptions for COPs from April 1, 2017 to March 31, 2018 was identified based on the presence or absence of a diagnosis for acute conjunctivitis and if the patient was initially evaluated for ophthalmologic symptoms by a primary care (PCP) or emergency department (ED) provider. A random sample of patients with a diagnosis of conjunctivitis were matched on demographics, site, and prescriber type with an equal number of those without diagnosis. Chart reviews were conducted to identify prescribing patterns, which included indications for COP use, optometry and ophthalmology (specialty care) referrals, screening for COP use and follow-up related to quality of care as determined by measurement of intraocular pressure (IOP) and symptom evaluation prior to and within 30 days of filling prescriptions. Patients previously diagnosed with chronic conjunctivitis, initially prescribed a COP by a non-VHA provider or received intraocular surgery were excluded. Descriptive statistics were used to compare demographic data and indicators of quality of care. This quality improvement project is exempt from human-subjects research and institutional review board review.
Results: From the interim analysis, approximately 25 percent of the sample was excluded, and 36 patients were included for the project. Overall, patients had a mean age of approximately 60 years, were mostly white males, and about one-third had additional risk factors for acute conjunctivitis. The majority of prescribers of COPs were specialty care, followed by ED and PCP. Among patients without a diagnosis of acute conjunctivitis, less than 50 percent of COPs filled had a documented indication for use, compared to greater than 75 percent of those with a diagnosis. Among both PCP and ED providers who prescribed COPs, only a small percentage screened for IOP prior to filling prescriptions. For follow-up visits among these prescribers, less than 25 percent of IOPs were rechecked within 30 days of filling a COP. Few patients had documentation of persistent ophthalmologic symptoms.
Conclusion: Specialty care providers constituted the majority of COP prescribing. In cases where PCP and ED providers were the prescribers, indications were not always documented, IOP was not typically measured prior to prescribing COPs nor was it measured within 30 days of follow-up. Overuse of these agents may promote antibiotic resistance and can exacerbate underlying ophthalmologic conditions. The results of this MUE may be used to improve prescribing of COP for conjunctivitis especially by non-specialty care providers in VHA.
Nathan Sylvain– PGY2 Pharmacy Resident Medication Use and Safety, Department of Veterans Affairs, Chicago, IL