Background The aim of rheumatoid arthritis (RA) treatment is to achieve remission as soon as possible, which can be accomplished by constant adapting of disease activity management. This can be evaluated using validated, internationally accepted measures of activity, such as disease activity score (DAS) 28 and functional disability questionnaires, such as PROMIS HAQ. Whether disease activity or functional ability of patients influence their satisfaction with health care has not been determined yet.
Objectives The aim of our study was to investigate how disease activity (DAS 28) and functional ability/disability (PROMIS HAQ) influence patient satisfaction in the health care process.
Methods We included 100 consecutive patients with RA (87 females, 13 males, average age 58.11 years (range 26-87)), who were regularly followed at our Rheumatology Department in the period between April and June 2012. Patients filled in PROMIS-HAQ during their check-up, DAS 28 was calculated and they were asked to fill in a questionnaire about health care satisfaction. The later included six important fields of satisfaction with health care: general satisfaction, conveying information, empathy of health care providers to the patient, professionalism of health care providers, conduct, accessibility of health care providers, and continuity of services. We used the Likert five-step evaluating scale from 1 to 5, by which 1 means “I agree to a great extent” and 5 means “I disagree to a great extent”. The average duration of disease was 10.89 years (range 1-32 years). Data were analysed with SPSS/PASW.
Results Our results indicate that with increasing disease activity (DAS 28), patient satisfaction with health care diminishes. Disease activity influences to the greatest extent satisfaction with conduct to the patient (p=0.003,) and patient opinion of the professional ability of health care providers (p=0.017). To a lesser extent, general satisfaction of the patient (p=0.044) is affected, as well as satisfaction with accessibility and continuity (p=0.046, test). DAS 28 does not influence patient satisfaction in regard to conveying information and empathy (p>0.05).
Similarly, increasing values of PROMIS-HAQ influenced satisfaction of patients with RA. The largest decrease was observed in satisfaction with conduct of health care providers towards the patient (from 4.26 at PROMIS HAQ <20, to 3.22 at greater than 70, p=0.007). Close behind are the variables of conveying information and professional training (with a difference of 0.92 average values).
Conclusions Taken together, our results indicate an important connection between disease activity, functional ability/disability, and the satisfaction of patients with health care. Higher disease activity or functional disability leads to diminished satisfaction with the health care system. Patients with active disease tend to experience more problems in everyday life, which affects their well-being and perception of their environment. Our findings add to the understanding of patients with RA who, during the active stage of their disease, need additional support and help from health care workers.
Disclosure of Interest : None declared
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