Application and feasibility of systemic lupus erythematosus reproductive health care quality indicators at a public urban rheumatology clinic

Abstract

Objective Quality indicators (QIs) are evidence-based processes of care designed to represent the current standard of care. Reproductive health QIs for the care of patients with systemic lupus erythematosus (SLE) have recently been developed, and examine areas such as pregnancy screening for autoantibodies, treatment of pregnancy associated antiphospholipid syndrome, and contraceptive counseling. This study was designed to investigate our performance on these QIs and to explore potential gaps in care and demographic predictors of adherence to the QIs in a safety net hospital. METHODS We performed a retrospective record review of patients with a diagnosis of SLE at Denver Health Medical Center (DH) through an electronic query of existing medical records and via chart review. Data was limited to female patients between the ages of 18–50 who were seen between July 2006 and August 2011. RESULTS One hundred and thirty-seven female patients between the ages of 18–50 were identified by ICD-9 code and confirmed by chart review to have SLE. Of these, 122 patients met the updated 1997 American College of Rheumatology SLE criteria and had an intact reproductive system. Only 15 pregnancies were documented during this 5-year period and adherence to autoantibody screening was 100 percent. We did not have any patients who were pregnant and met criteria for pregnancy associated antiphospholipid syndrome. Sixty-five patients (53%) received potentially teratogenic medications and 30 (46%) had documented discussions about these medications’ potential risk upon their initiation. Predictors of whether patients received appropriate counseling included younger age (OR 0.93, CI 0.87-0.98) and those who did not describe English as their primary language (OR 0.29, CI 0.09-0.96). These remained statistically significant in multivariate analysis. CONCLUSIONS We were able to detect an important gap in care regarding teratogenic medication education to SLE patients of childbearing potential in our public health academic clinic as only 1 in 2 eligible patients had documented appropriate counseling at the initiation of a teratogenic medication.

Prevalence of sexual dysfunction in women with systemic lupus erythematosus and its related factors

“…The authors found that the rate of avoiding a sexual relationship was higher (50%) and the rates of desire, arousal, lubrication, and orgasm were lower in patients with SLE [ 7 ]. Sexual dysfunction is associated with physical complaints, obsessive-compulsive symptoms, interpersonal sensitivity, psychoticism, decreased vitality, and impaired social function and mental health [ 8 , 9 ].…”

Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic

“…Key barriers to performing reproductive health screening and other quality indicators include time and lack of a supportive infrastructure, including efficient ways to document counseling in the EHR. 8,15,16 Authors of several studies have described approaches to teratogenic medication education for adult patients by using computer-based support. [17][18][19] Although satisfaction was high in patients who received counseling, in 1 study of a computerbased support tool, 43% of women still received no medication counseling.…”

Increasing contraception use among women receiving teratogenic medications in a rheumatology clinic

“… 5 Studies in patients with SLE reveal that one-third to one-half of patients do not report or do not have documented discussions regarding potential pregnancy risks with initiation of teratogenic medications. 7 8 Lack of adherence to suggested quality measures places our patients at increased risk of harm, but also presents an opportunity for QI.…”