Medication adherence strategies for hydroxychloroquine: qualitative findings to inform intervention development

Hydroxychloroquine (HCQ) is the cornerstone of SLE therapy because it improves injury-free survival in all patients with
SLE.
However, non-adherence to the key therapy – HCQ – is a cause for concern
.
Sub-HCQ nonadherence is strongly associated
with a 6-fold higher risk of severe lupus recurrence, a 45% higher rate of lupus hospitalization, and an 8-fold higher risk of death.
In addition, patients from black races are at twice the risk of HCQ non-adherence, and patients from disadvantaged backgrounds have even worse compliance rates, highlighting the unique barriers
these groups may face that lead to non-adherence.
However, most adherence interventions lack the insights and tailored strategies of different patients to address their unique challenges with
HCQ.

Target: Patients identified as black and from disadvantaged backgrounds had twice as high non-adherence to hydroxychloroquine (HCQ), which led to worse
lupus outcomes and variations.
However, most adherence interventions lack tailored strategies for ethnically and socioeconomically diverse patients who face the unique challenges
of HCQ.
We aimed to examine broadly representative patient groups of SLE patients and physicians' perceptions of HCQ adherence and adherence strategies to redesign adherence interventions
.

Characteristics of patients and healthcare advisors (n = 20):

Methods: The investigators conducted four virtual focus groups (90 minutes each) and recruited 11 ethnically and socioeconomically diverse SLE patients
from two health systems.
In addition, we held two focus group sessions
with nine healthcare consultants.
In focus groups, patients: (1) shared their views on the use of HCQ; (2) common concerns leading to non-compliance; (3) discuss strategies to overcome concerns; (4) Prioritize strategies from most valuable to least valuable to inform adherence
interventions.
In two separate focus groups, healthcare advisors provide feedback to optimize adherence interventions
.
Using content analysis, we analyzed transcripts to redesign our adherence interventions
.

Patient's perceptions and insights on hydroxychloroquine (the size of the word/phrase matches the frequency listed):

Results: Fear of side effects was the most common barrier phrase
mentioned by patients.
Key themes of patient concerns about HCQ include: information gaps, logistical barriers, misunderstandings, and medication burden
.
Finally, patients came up with adherence strategies and ranked the most valuable strategies, including co-payment assistance, individual reminders, and more
.
Patients and healthcare advisors informed the design of laminated versions of adherence interventions to link
each barrier category to four to six patient-recommended adherence strategies.

Overall, the study provides a healthcare provider-informed, patient-informed and endorsed adherence intervention that assesses adherence and facilitates tailored adherence discussions using patient-recommended strategies to clarify misconceptions and encourage the use of HCQ
.
The investigator multifaceted intervention guided clinicians on nonadherence through eight patient-recommended adherence disorder categories and the first four to six patient-recommended strategies
.

References:

Garg S, Chewning B, Gazeley D, Gomez S, Kaitz N, Weber AC, Rosenthal A, Bartels C.
Patient and healthcare team recommended medication adherence strategies for hydroxychloroquine: results of a qualitative study informing intervention development.
Lupus Sci Med.
2022 Aug; 9(1):e000720.
doi: 10.
1136/lupus-2022-000720.
PMID: 35914839; PMCID: PMC9345084.