Improving Hydroxychloroquine Adherence through Patient- and Provider-Informed Interventions

New research identifies highly relevant and tailored intervention strategies aimed at supporting hydroxychloroquine adherence across diverse lupus populations. Hydroxychloroquine (known commercially as Plaquenil) is a key treatment for lupus, and nonadherence to one’s Plaquenil medication regimen has been linked to significantly higher risk of lupus flares, higher rates of hospitalization and higher mortality risk.

Non-adherence rates are especially high among Black and socioeconomically disadvantaged populations. Yet, most adherence strategies lack tailored approaches for diverse patients who face unique challenges with hydroxychloroquine.

To better understand and address these challenges, researchers conducted focus group interviews with racially and socioeconomically diverse people with lupus to learn about their perspectives on hydroxychloroquine, concerns or barriers keeping them from using the medication and strategies to help overcome their concerns.

Several adherence barriers were identified, and at least four patient-suggested strategies were linked to each barrier, including:

• Barrier 1: Prescription Payment/Refills
  • Example Solution: Copay assistance or coupons
• Barrier 2: Medication Timing/Dose Schedule
  • Example Solution: Visual reminders (e.g., an open pillbox, flashing cap)
• Barrier 3: Side Effects and Medication Interactions
  • Example Solution: Tailored strategies to prevent/manage side effects (e.g., taking medication with dinner)
• Barrier 4: Unclear Benefits of Medication
  • Example Solution: Explanation of long-term benefits and response lag (e.g., what to expect from six weeks to six months)
• Barrier 5: Long-term Effects and Interactions
  • Example Solution: Rationale for clinical testing (e.g., clarifying urine tests are for lupus monitoring, not hydroxychloroquine monitoring)
• Barrier 6: Understanding Expectation vs. Outcome
  • Example Solution: Focused discussion on lupus lab tests/results and symptom response to medications
• Barrier 7: Other Concerns and Information Needs 
  • Example Solution: Patient-centered clinical counseling (e.g., checking in on how patients are feeling)

Researchers also interviewed several healthcare advisors for additional feedback and ideas to ensure the strategies developed were simple, feasible and accessible. Future studies will aim to put these strategies into practice and examine their impact on improving hydroxychloroquine adherence. Learn more about hydroxychloroquine: benefits, side effects and dosing.

Read the study