Improving Guideline Directed HCQ Dosing Among Patients of the Miami VA’s Rheumatology Department

Summary: Background and Objectives Hydroxychloroquine is the only treatment for Systemic Lupus Erythematosus found to reduce mortality. However, retinal toxicity remains a major concern. If it develops, vision loss may be progressive and irreversible despite drug discontinuation. Hydroxychloroquine weight-based dosing guidelines have been created to reduce the risk of retinal toxicity. The objective of this project was to improve compliance with hydroxychloroquine weight-based dosing guidelines with a one-time educational intervention delivered to Miami VA rheumatology providers. Methods Between 3/14/22-2/26/24 weight-based dosing data was gathered and analyzed about the Miami VA rheumatology prescribers from the “Hydroxychloroquine Dashboard” developed by Measurement Science Queri, from the US Department of VA. A one-time educational lecture was provided to Miami VA rheumatology providers on 3/17/23 as the intervention. One year pre-intervention and one year post-intervention data was collected and analyzed for changes in hydroxychloroquine dosing patterns Results Results showed that the intervention decreased the percentage of patients receiving above the maximum recommended hydroxychloroquine dose (5.2 mg/kg/day) by 2.68% after 1 year (15.51% pre-intervention average vs 12.75% post-intervention average, p = 0.0016). Additionally, our results now align closer with the national VA average of patients taking higher than the recommended dosage, with a statistically significant greater percentage decrease in over-dosing compared to the national trend, (-8.80% national percent change vs -17.79% post-intervention change, p = 0.0134) Conclusions This QI initiative resulted in improved compliance with hydroxychloroquine dosing guidelines among Miami VA rheumatologists. The one-year duration of post-intervention improvement suggests that the effect was sustained. A major takeaway from this QI project is that targeted educational interventions can produce meaningful durable changes in the patient outcome and safety. Further studies may be needed to identify the role of ongoing education to maintain and improve efficacy.