Background/Purpose: To assess correlates of the quality of patient-clinician communication in a diverse cohort of adults with rheumatoid arthritis (RA).

Methods: Data were obtained through structured 30-minute telephone interviews conducted in English or Spanish. Subjects were enrollees of the Rheumatoid Arthritis Outcomes Study (RA OS), a longitudinal cohort of adults with RA. Two questions from the Consumer Assessment of Healthcare Providers and System (CAHPS) were used to assess RA patients’ experience of communication with their rheumatologist: “How often did this doctor check to make sure you understood everything?” and “How often did this doctor spend enough time with you?” Responses options consisted of 5 choices ranging from “never” to “always.” We report the proportion of subjects who responded “always” which is considered by CAHPS as the “Top-box” score. Logistic regression was used to model the quality of communication as a function of demographics (age, gender, race/ethnicity), education, health literacy (single-item literacy screener), English language proficiency, disease characteristics (duration, fatigue, disease activity), depression (score ≥10 on the Patient Health Questionnaire 9), and insurance.

Results: 395 adults with RA were surveyed with a mean age of 61 years, 89% were female, 46% white, 31% Latino. Nearly one-third (31%) had limited health literacy (LHL) and 17% had limited English language proficiency (LEP). Mean disease duration was 23 ± 12 years, 39% reported moderate fatigue and 18% severe, and 17% had a PHQ-9 score ≥10. In multivariate models controlling for disease activity, fatigue, and depression (see table), RA patients with LHL and LEP were more likely to report that their rheumatologist always checked for understanding. However, patients with LEP were less likely to report that their doctor always spent enough time with them, as were Latinos (compared to all other race/ethnic groups). .

Conclusion: Despite the finding that over 90% of RA patients with limited English language proficiency perceive that rheumatologists always check for understanding, only 38% of these same patients and 40% of Latinos report that doctors spend enough time with them. These results were independent of disease activity and depression. Providing high quality, patient-centered care in RA is important for all patients, especially those with barriers to communication. Awareness and interventions to enhance quality of communication and that address cultural expectations for care are needed for vulnerable populations.