title: Misalignment between physicians and patient satisfaction with psoriatic arthritis disease control.
abstract: The main objective of the present study is to evaluate the misalignment between psoriatic arthritis (PsA) patient- and physician-reported satisfaction with PsA control. Data came from the Adelphi Rheumatology Disease Specific Programme, a retrospective, cross-sectional survey of US-based rheumatologists and patients. Physicians provided satisfaction and clinical characteristics on tender joint count, swollen joint count, and percent body surface area (BSA) affected by psoriasis. Patients provided data on satisfaction, the Work Productivity Activity Impairment and Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires. Based on their satisfaction response, patient-physician pairs were classified into aligned (both satisfied or dissatisfied) or misaligned (rated satisfaction differently) groups. Multivariate analysis evaluated association of characteristics with misalignment. Among 305 paired patient-physician records analyzed, 23.6% were misaligned and 76.4% were aligned. The misaligned group had shorter disease duration (mean years, 5.2 vs. 6.4), used fewer biologic disease-modifying antirheumatic drugs (49.3 vs. 62.9%), had more swollen (mean, 3.7 vs. 1.9, P = 0.0002) and tender joints (mean, 5.6 vs. 2.9, P < 0.0001), greater proportion of patients with comorbidities (72.2 vs. 63.1%), and >3% BSA affected by psoriatic skin lesions (64.2 vs. 55.1%). Misaligned patients reported greater work impairment (mean, 38.7 vs. 21.4, P = 0.0004), daily activities (mean, 38.7 vs. 22.3, P < 0.0001), and higher disease burden (mean HAQ-DI; 0.56 vs. 0.37, P = 0.0001). Multivariate analysis found the number of swollen joints (P = 0.02) and HAQ-DI score (P = 0.03) was significantly associated with misalignment among all patients; however, not in the subgroup of employed patients. Patient-physician misalignment is associated with increased disease activity and disability among patients with PsA.
authors.affiliation: Department of Rheumatology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Furst
authors.affiliation: Scott & White Health Plan, Temple, TX, USA.
authors.forename: Melody
authors.initials: M
authors.lastname: Tran
authors.affiliation: Adelphi Real World, Adelphi Mill, Cheshire, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Sullivan
authors.affiliation: Adelphi Real World, Adelphi Mill, Cheshire, UK.
authors.forename: James
authors.initials: J
authors.lastname: Pike
authors.affiliation: Adelphi Real World, Adelphi Mill, Cheshire, UK.
authors.forename: James
authors.initials: J
authors.lastname: Piercy
authors.affiliation: Health Economics & Outcomes Research, Immunology & Dermatology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936, USA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Herrera
authors.affiliation: Health Economics & Outcomes Research, Immunology & Dermatology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936, USA. Jacqueline-1.palmer@novartis.com.
authors.forename: Jacqueline B
authors.initials: JB
authors.lastname: Palmer
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000503:physiopathology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007596:Joints / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D012867:Skin / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D018501:Antirheumatic Agents
keywords: Disease activity; Misalignment; Patient-physician survey; Psoriatic arthritis; Swollen joint count; Tender joint count