Analysis of patient-physician discrepancy in global assessment of systemic autoimmune myopathy disease activity

Abstract

ObjectiveTo compare the perception of disease activity (DA) between adult patients with systemic autoimmune myopathies (SAMs) and their physicians, and analyse possible sources of discordance. MethodsThis cross-sectional study included 75 patients with SAMs. Patients and physicians rated the global DA on a 0-10 cm visual analogue scale. A discrepancy score was calculated by subtracting physician assessment from patient assessment. Three groups were defined: (I) no discrepancy: difference within -2.0 to +2.0; (II) negative discrepancy (ND): difference <-2.0 (patient underrated DA in relation to physcian); (III) positive discrepancy (PD): difference >+2.0 (patient overrated DA in relation to physician). Logistic regression was used to identify predictors of discordance. ResultsDiscordance in patient-physician assessment of DA was found in 21 (28%) cases. ND was observed in 3 (4%), PD in 18 (24%), and no discrepancy in 54 (72%) assessments. Due to the small number, ND cases were excluded from the analysis. PD was associated with older age, personal history of depression, past joint involvement, higher MMT-8 and lower extramuscular DA. In the regression model, for each additional year of age, the chance of PD increases, on average, by 9% (OR 1.09; p=0.034). Personal history of depression increases the chance of PD by 829% (OR 9.29; p=0.016). ConclusionAlmost 30% of patients had discordance in DA assessment from their physicians. The majority of them overrated their DA.These patients tend to be older and are more likely to have personal history of depression, past joint involvement, and milder disease.

Understanding Discordant Perceptions of Disease Severity Between Physicians and Patients With Eczema and Psoriasis Using Structural Equation Modeling

“…Of 44 physicians recruited, 20 (45.5%) were male, 24 (54.5%) were aged between 31 and 40 years, 20 were senior residents or fellows, and 14 were consultants or attending physicians. The median (IQR) number of patients recruited per physician was 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) patients. The data were near complete with less than 0.01% missing data points.…”

“…[2][3][4][5][6][7][8] Most report a tendency for patients to report higher disease severity relative to the physician. [2][3][4][5][6] Previous studies focus heavily on demographic and disease factors, reporting a tendency for female patients, 5 older patients, [9][10][11][12] and those with concurrent psychiatric disorders to report higher severity. 2,4,6,8 Inconsistent associations were seen with education level, 2,5 initial quality of life (QOL), 3,5 and disease severity.…”