Background/Purpose: Although survival in SLE has improved, quality of life (QOL) remains poor. Physicians aim to reduce suffering and improve health outcomes, while maximizing efficiency and reducing costs. Patient satisfaction with care (SC) correlates with adherence, health behaviors and outcomes. However, SC may be influenced by patient, provider, care-processes and disease variables. This study aims to determine the modifiable and non-modifiable correlates of SC in SLE.

Methods: 1262 consenting patients, meeting ACR criteria for SLE, were recruited for this study from 2009-2016.  Demographics, disease activity (SELENA-SLEDAI) and QOL (LupusPROv1.7) were collected. LupusProv1.7 includes a four-item domain on SC covering physician accessibility, education, physician discussion and monitoring of medication side effects, and physicians’ understanding of impact of lupus on patients’ lives.   Regression analyses were conducted using patient (age, gender, ethnicity, education, social support) and disease (duration, disease activity, damage, medications, QOL) variables as independent predictors. P ≤0.05 was considered significant.

Results: Mean (SD) age was 41.7 (13.5) yrs; 93% were female. Ethnic composition was: African American 10%, Caucasian 23%, Hispanic 18%, Asian 48%. On univariate analysis, age, Asian ethnicity, current steroid use and QOL (desires-goals) were inversely associated with SC, while Hispanic and African-American ethnicity, disease activity (total score, pyuria, proteinuria, hematuria, urine casts), QOL (cognition, social support, coping) were directly associated with SC (Table 1). On multivariate analysis, ethnicity (positive for African Americans and Hispanics, negative for Asians), disease activity (pyuria) and QOL (desires-goals, social support and coping) remained independent predictors of SC.

With stepwise regression modelling (Table 1), African American and Hispanic ethnicity, total SLEDAI and pyuria, and QOL (social support and coping) were positively associated with SC, while Asian ethnicity and QOL (desires-goals) were negatively and independently associated with SC.

Conclusion: Asian patients have worse SC even after adjusting for demographics, disease activity, treatment and QOL. This requires further investigation into the role of culture, health behaviors and healthcare systems, but also suggests physicians need to be more attentive to the needs of Asian patients.  Patients with greater disease activity have better SC, perhaps from greater interactions with physicians and ancillary services. SC thus may not be a good surrogate for tracking patients’ health outcomes and quality of care. Social support and coping are potentially modifiable. Evaluation of patients’ external and internal resources (social support and coping) using a bio-psychosocial model of health for SLE is suggested.