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Abstract
Background An important element of the management of rheumatoid arthritis (RA) is the discussion of the degree to which patients are currently satisfied with their disease control. However, satisfaction with treatment disease control is not always aligned between patients and physicians.
Objectives To explore the degree of discrepancy between physicians' and patients' satisfaction regarding RA disease control and to understand factors that may contribute to this discrepancy.
Methods A multivariate logistic regression analysis was performed using ADELPHI RA Disease Specific Program (DSP) data in the US and EU5. Age and gender were forced in the model, and other covariates were included if the univariate P value was <0.20. The missing indicator method was used to handle missingness.
Results A total of 948 patients were included in this analysis. Overall, there was a discrepancy between physicians' and patients' perspectives on RA disease control in 26% of physician/patient pairs (Figure). Of 90 patients who rated their satisfaction as “not satisfied, and I believe better control can be achieved for my condition,” 23.3% (n=21) had physicians who reported being satisfied with the RA disease control achieved. In contrast, of 714 patients who reported being satisfied with the RA disease control achieved, 9.2% (n=66) had physicians who rated their satisfaction as “not satisfied, and I believe better control can be achieved for my condition”. After controlling for other covariates, some patients were more likely to disagree with their physicians' assessment of RA disease control, including those with the following disease characteristics: (1) longer disease duration (adjusted odds ratio [95% CI], 1.01 [1.00, 1.02]; P=0.03); (2) compared to DAS28 (CRP) ≤2.6 as reference level, higher disease activity (based on DAS28): DAS28 >2.6 to ≤3.2 (1.84 [0.96, 3.53]); DAS28 >3.2 to ≤5.1 (2.65 [1.45, 4.84]); DAS28 >5.1 (2.42 [1.02, 5.78]; all P≤0.05); (3) greater activity impairment (based on the WPAI questionnaire; 1.10 [1.03, 1.17]; P=0.003). In contrast, patients who were in remission were more likely to agree with their physicians' assessment of disease control (0.43 [0.32, 0.60]; P<0.0001). In the multivariate analysis, a significant predictor of worse assessments of disease control by patients versus their physicians was greater activity impairment, based on the WPAI (1.31 [1.18, 1.44]; P<0.0001). In contrast, a significant predictor of better assessment of disease control by patients versus their physicians was a lower EuroQol-5 Dimension health status index score (indicating worse health status; 0.40 [0.17, 0.94]; P=0.04).
Conclusions Results of this analysis showed a discrepancy between physicians' and patients' perspectives on RA disease control. Patients whose condition (objectively measured by longer disease duration, higher disease activity, and greater activity impairment) was worse were more likely to disagree with their physicians regarding their disease control. More impaired utility and health economic measurements were strongly associated with patients having a worse assessment of disease control than physicians. These results highlight need for further research to identify causes of this discrepancy in stated satisfaction.
Disclosure of Interest S. Peterson Shareholder of: Janssen, Employee of: Janssen, E. Sullivan Employee of: Adelphi Real World, D. Kielar Shareholder of: Janssen, Employee of: Janssen, N. Li Employee of: Janssen