Background/Purpose:

Psoriatic Arthritis (PsA) is a chronic immune related condition affecting the joints and commonly occurs alongside psoriasis. Well-established physician patient relationships are instrumental to obtaining the best patient outcomes.

The objective of this analysis was to assess the extent of misalignment between physicians and their PsA patients in terms of satisfaction with current control of their PsA. We then compared aligned and misaligned patients in terms of demographic factors, drug treatments, symptoms, comorbid conditions and patient reported outcomes.

Methods:

Data were drawn from the Adelphi 2011 and 2014 Rheumatology Disease Specific Programmes surveys of rheumatologists and their PsA patients in the USA. Rheumatologists with responsibility for managing PsA patients were recruited and provided patient demographics, clinical details, comorbidities and satisfaction with PsA treatment. Patients reported their satisfaction, and completed the Work Productivity Activity Impairment (WPAI) questionnaire, and alternative HAQ-DI (excluding aids and devices) questionnaire.

Levels of satisfaction agreement between physician and patient responses were constructed and compared: aligned (physician and patient both satisfied, or physician and patient both dissatisfied with PsA treatment) and misaligned (physician and patient reported satisfaction with PsA treatment was different). Descriptive statistics including means and frequencies were derived.

Results:

From 305 paired rheumatologists and PsA patient records, 233 (76.4%) were ‘aligned’, consisting of 65.3% with both physician and patient satisfied, and 11.1% with both dissatisfied.72 (23.6%) cases were ‘misaligned’. The aligned and misaligned groups were similar in terms of age (mean 50.0, 49.8) and sex (% female: 44.6, 45.8). However, the aligned group had longer time since diagnosis compared with misaligned (mean years: 6.4, 5.2) and were more likely to receive biologic DMARD (bDMARD) therapy (% receiving bDMARD: 62.9, 49.3).

The misaligned group tended to be more symptomatic, having higher TJC (mean 5.6 vs. 2.9), SJC (mean: 3.7, 1.9), higher BSA (>3% BSA affected: 64.2% vs. 55.1%), higher number of PsA symptoms (mean: 6.8, 4.9). The most common concomitant conditions were hypertension (28.9%), elevated cholesterol (20.0%), depression (14.1%), obesity (13.8%) and anxiety (10.8%). A greater proportion of misaligned patients had depression (20.8% vs. 12.0%) and anxiety (15.3% vs. 9.4%). As reported in the WPAI, the misaligned were also more impaired in their overall work (mean 38.7% vs. 21.4%), while at work i.e. presenteeism (mean 36.2% vs. 16.5%) and in their daily activities (mean 38.7% vs. 22.3%). Additionally they had higher disability (mean alternative HAQ-DI score: 0.563 vs. 0.369).

Conclusion:

Misalignment between rheumatologists and their PsA patients in satisfaction with PsA treatment exists in almost a quarter of cases. In cases of misalignment, disease severity and patient reported outcomes were worse. The findings suggest that a greater degree of alignment might result in improved outcomes, although further research would be required to verify this hypothesis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/misalignment-between-physician-and-patient-satisfaction-with-current-psoriatic-arthritis-treatment/