Baseline Retinal Examinations in Patients With Systemic Lupus Erythematosus Newly Initiating Hydroxychloroquine Treatment in a US Medicaid Systemic Lupus Erythematosus Population, 2000–2010

Objectives Baseline retinal examination has long been recommended at hydroxychloroquine (HCQ) initiation, but it is unknown how well this guideline is followed. We investigated baseline eye examinations among U.S. Medicaid SLE patients initiating HCQ. Methods Using billing codes, we identified SLE patients aged 18-65 enrolled in Medicaid, residing in the 29 most populated U.S. states from 2000-2010. New HCQ users were identified by filling a prescription, with none in the preceding 12 months. Baseline retinal exams were identified within 30 days before to one year after this index prescription. We examined proportions of patients receiving retinal exams over the study years and compared characteristics of those who did and did not receive exams using bivariable and multivariable logistic regression models. Results Of 12,755 SLE patients newly starting HCQ, 32.5% received baseline dilated eye exams. The proportions of individuals receiving baseline eye exams did not significantly change during these years (31.0% to 34.4%, p for trend 0.12). Factors associated with increased likelihood of examinations included female sex, Asian versus White race, and receiving a higher number of laboratory tests during the preceding year. Lower proportions of Black and Native American versus White SLE patients had baseline retinal exams. Conclusion Only one third of Medicaid SLE patients newly initiating HCQ received recommended baseline retinal examinations and this proportion did not significantly increase during these years. The sociodemographic variation in this indicated care has been observed for other recommended medical care for SLE and requires both further investigation and interventions to address it. This article is protected by copyright. All rights reserved.