Real-world disparities between patient- and clinician-reported outcomes: results from a disease-specific program in depression and anxiety.
OBJECTIVE
The purpose of this study was to identify potential discordance between physician and patient rated measures of depression used by primary care physicians and psychiatrists.


METHODS
This study collected data from primary care physicians and psychiatrists in the United States between October and December 2009.


METHODS
A real-world, cross-sectional study was conducted using the Neuroses Disease-Specific Programme (Adelphi Real World, Macclesfield, United Kingdom). Treatment practice data were collected by 180 physicians (100 primary care and 80 psychiatrists) who were asked to provide information for the next 15 outpatients presenting prospectively with symptoms of anxiety and/or depression (n = 2,704 patients). The primary outcome measures were the Clinical Global Impressions-and Patient Global Impressions-Improvement scales, completed by both physicians and their matched patients, respectively. Cohen's kappa coefficient (κ) was calculated to assess the level of agreement between the Clinical Global Impressions-and Patient Global Impressions-Improvement scale responses.


RESULTS
Physician- and patient-rated overall improvement in illness was 82% and 89%, respectively. Results of the kappa analysis demonstrated fair agreement between patients and physicians regarding overall improvement in illness (44% agreement; κ= 0.23). Physician ratings of patient improvement progressively decreased with increased severity of illness.


CONCLUSIONS
These real-world data suggest that the degree of reduction in symptoms of anxiety and/or depression may be estimated differently by physicians when compared with their patients. Understanding the potential for disparities between physician- and patient-rated measures in reviewing patient care, particularly in patients with more severe depressive symptoms, can help ensure that treatment plans are aligned with patient needs.
Shannon Lubaczewski's, PharmD, MS, 15-year career in the pharmaceutical industry includes diverse experiences such as drug manufacturing and packaging, project management, vendor management, clinical quality auditing, pharmacovigilance auditing, clinical pharmacy, and clinical study management from initial planning through coauthoring of the clinical manuscript. Shannon earned a bachelors degree in pharmacy at the Philadelphia College of Pharmacy and Science. She completed a master's degree in quality assurance and regulatory affairs from Temple University. She also earned a doctorate in pharmacy from the University of the Sciences in Philadelphia. She maintains licensure in the state of Pennsylvania. Jason Shepherd, Project Director, Adelphi Real World, joined Adelphi in 2001 after previous marketing research roles with the Medical Research Council, The Research Business International, and NOP in London. He has worked across many therapy areas and is currently responsible for the Neuroses Disease-Specific Programme for Adelphi Real World. Rana Fayyad, PhD, is a statistician with 20 years in the Pharmaceutical industry. Rana has been an employee of Pfizer Inc. for 14 years and, during her career, worked on multiple therapeutic areas, including cardiovascular, oncology, neuroscience, and ophthalmology, covering phases II-IV, as well as publications, and regulatory responses. Rana obtained her PhD in statistics from Colorado State University. Christine J. Guico-Pabia, MD, MBA, MPH, is a physician executive with diverse health care management experience in pharmaceutical, managed care, public health, and medical delivery environments. Christine has a sustained track record of effectively developing and launching innovative pharmaceutical, medical informatics, and managed care products with particular expertise in neuroscience and women's health. She joined Wyeth Pharmaceuticals, now Pfizer Inc., more than 6 years ago as Director and later as Senior Director, Global Med
Shannon
S
Lubaczewski
Jason
J
Shepherd
Rana
R
Fayyad
Christine J
CJ
Guico-Pabia
D000328:Adult; D001007:Anxiety / Q000628:therapy*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D016896:Treatment Outcome