Background/Purpose: A global estimate on a 100 mm Visual Analogue Scale (VAS) assessed by patients (PATGL) and physicians (DOCGL) is commonly used to measure disease activity and to monitor treatment response in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Several studies in RA have shown that PATGL and DOCGL are discordant (>20 mm difference) in about 1/3 of the encounters and have mainly focused on whether clinical measures and patient characteristics explain this. The influence of physician characteristics has not yet been examined across different arthritis diagnoses. Studies in other clinical areas suggest that treatment decisions are affected by physician gender and clinical experience. The aim of the study was therefore to assess whether physician characteristics are associated with discordance between DOCGL and PATGL in patients with RA, AS and PSA.

Methods: Physician characteristics were collected by a questionnaire sent to DANBIO physicians (n = 265). Patient characteristics and clinical measures as well as PATGL and DOCGL scores were obtained from DANBIO first encounters. A difference between DOCGL and PATGL of up to 20 mm was considered concordant, yielding three groups: PATGL>DOCGL, PATGL=DOCGL and DOCGL>PATGL. The two latter groups were merged due to few patients in DOCGL>PATGL. We used mixed effects logistic regression analyses with discordance (yes/no) as the dependent variable, performing independent analyses for each diagnosis. The model was adjusted for patient and clinical variables (e.g. age, gender, disease activity, treatment, disease duration), which were entered as covariates.

Results: 90 physicians (44% females, 61% rheumatologists, median age 52 years) returned the questionnaire (34%) and were pairwise matched with 7,619 RA, 1,291 PsA and 469 AS first encounters.

Discordance was independent of physician’s gender and age, both for patients with RA, and for patients with AS or PSA, see table. Less experienced physicians (i.e. not yet specialized) had lower odds of discordance 0.69-0.92, although it only reached statistical significance in patients with RA, see table.

Table. Mixed effects logistic regression of predictors of discordance between patient and physician assessments of global disease activity.
	RA (N: 7,619 encounters)		AS (N: 469 encounters)		PsA (N: 1,291 encounters)
	Adjusted OR  ( 95% CI)	P	Adjusted OR  ( 95% CI)	p	Adjusted OR  ( 95% CI)	p
Physician gender, male (female=1.0)	0.83 (0.69-1.01)	NS	1.25 (0.70-2.26)	NS	1.04 (0.73-1.49)	NS
Physician age >52 years (≤52 =1.0)	1.10 (0.89-1.37)	NS	1.16 (0.59-2.30)	NS	1.17 (0.79-1.74)	NS
Rheumatologist (specialized), no (yes=1.0)	0.72 (0.55-0.93)	*	0.69 (0.31-1.52)	NS	0.92 (0.56-1.51)	NS
Concordant group is reference group. The model was adjusted for swollen and tender joint counts (0-28), C-reactive Protein, disease duration (years), biological treatment (yes/no), country of medical exam, and doctor’s subjective rating of factors important for DOCGL (inflammation, fibromyalgia, structural joint damage, comorbidity and social factors). To account for clustering by physician and patient, these variables were included in the model as random effects. ***=p<0.001, **=p<0.01, *=p<0.05, NS=not significant

Conclusion:

: Data from clinical practice covering >9,000 DANBIO first encounters between 90 physicians and their patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis showed that, regardless of diagnosis, discordance (i.e. difference between patient’s and doctor’s global scores >20 mm) was independent of physician’s age and gender. This is reassuring for the monitoring of patients in routine care. Having specialized in rheumatology seemed to be associated with increased odds of discrepancy compared to less experienced colleagues.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-physician-gender-age-and-clinical-experience-associated-with-discrepancy-in-global-disease-score-in-rheumatoid-arthritis-ankylosing-spondylitis-and-psoriatic-arthritis-data-from-the-natio/