Systemic lupus erythematosus: Auditing standard of care in Qatar

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical presentations influenced by ethnicity, geography, and healthcare practices. This audit evaluated adherence to key quality indicators for SLE management at Hamad General Hospital (HGH), a major public tertiary care center in Doha, Qatar, in line with international standards. Methods: A retrospective cross-sectional audit was conducted between March and July 2024 involving 61 patients with SLE attending the rheumatology clinic at HGH. This audit assessed adherence to four selected key quality indicators: hydroxychloroquine (HCQ) use, annual proteinuria screening, annual ophthalmologic screening for HCQ-related retinopathy, and medication reconciliation documentation during the most recent clinic visit. Results: All patients were initiated on HCQ, with 11.5% discontinuing it due to adverse effects. Annual proteinuria screening was completed in 95% of patients. Ophthalmologic screening for HCQ-related retinopathy was documented in 65%, and medication reconciliation was completed in 72% of cases. The cohort represented a total of 21 nationalities, including Qataris who accounted for 31%-a proportion higher than their estimated 11.6% representation in Qatar's national population. Conclusion: While adherence to HCQ initiation and renal monitoring met international benchmarks, ophthalmologic screening and medication reconciliation rates were suboptimal and required improvement. Targeted system-level and educational interventions are planned to enhance adherence to these standards. Re-audit following implementation will be essential to assess progress and to sustain the quality of care.