PT  - JOURNAL ARTICLE
AU  - Deanna Cettomai
AU  - Allan C. Gelber
AU  - Lisa Christopher-Stine
TI  - A Survey of Rheumatologists’ Practice for Prescribing Pneumocystis Prophylaxis
AID  - 10.3899/jrheum.090843
DP  - 2010 Mar 01
TA  - The Journal of Rheumatology
PG  - jrheum.090843
4099  - http://www.jrheum.org/content/early/2010/02/24/jrheum.090843.short
4100  - http://www.jrheum.org/content/early/2010/02/24/jrheum.090843.full
AB  - 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%). Conclusion 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.