A survey of rheumatologists' practice for prescribing pneumocystis prophylaxis.
OBJECTIVE
Pneumocystis pneumonia (PCP) occurs in immunocompromised hosts, in both the presence and absence of human immunodeficiency virus (HIV) infection, with substantial morbidity and a heightened mortality. We assessed practice patterns among rheumatologists for prescribing PCP prophylaxis.


METHODS
Invitations to an online international survey were e-mailed to 3150 consecutive members of the American College of Rheumatology.


RESULTS
Completed surveys were returned by 727 (23.1%) members. Among respondents, 505 (69.5%) reported prescribing prophylaxis. Factors associated with significantly higher frequency of prescribing PCP prophylaxis included female gender (OR 1.47, p = 0.03), US-based (OR 1.77, p = 0.004), academic-based (OR 2.75, p < 0.001), in practice less than 10 years (OR 4.08, p < 0.001), having previously treated PCP (OR 2.62, p < 0.001), and in a practice with a higher proportion of patients maintained on chronic glucocorticoids (OR 2.04, p < 0.001) or other immunosuppressant medications (OR 3.19, p = 0.003). In multivariate analysis, rheumatologists early in their careers and those with academic and US-based practices were more likely to prescribe prophylaxis. Among prescribers, the most important determinants for issuing prophylaxis were treatment regimen (68.6%), rheumatologic diagnosis (9.3%), and medication dosage (8.3%).


CONCLUSIONS
Nearly one-third (30%) of the rheumatologists surveyed reported that they never prescribed PCP prophylaxis. While the patient characteristics for which prophylaxis was prescribed varied widely, physician demographics were strongly predictive of PCP prophylaxis use. These findings suggest that development of consensus guidelines might influence clinical decision-making regarding PCP prophylaxis in HIV-negative patients with rheumatologic diagnoses.
Cettomai
Deanna
D
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
Gelber
Allan C
AC
Christopher-Stine
Lisa
L
D016009:Chi-Square Distribution; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D008297:Male; D015999:Multivariate Analysis; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000276:immunology* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012216:Rheumatic Diseases / Q000276:immunology*; D012219:Rheumatology; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States