Discordance Between Physician- and Patient-Reported Disease Severity in Adults with Atopic Dermatitis: A US Cross-Sectional Survey

Abstract

BackgroundThere is limited understanding of severity rating of atopic dermatitis in clinical practice.ObjectivesTo evaluate the agreement between physician- and patient-rated severity of atopic dermatitis.MethodsData were collected from the 2014 Adelphi US Atopic Dermatitis Disease Specific Programme, a cross-sectional survey of physicians and their patients with a history of moderate-to-severe atopic dermatitis; patients voluntarily completed a questionnaire. Current disease severity (mild/moderate/severe), based on personal judgment, was rated independently by patients and their physicians. The weighted kappa statistic identified level of agreement between physicians and patients. Bivariate analyses characterized agreement; multi-nomial logistic regression identified factors associated with discordance.ResultsOverall, 678 patients were included (369 [54.4%] were women, 525 [77.4%] were White, mean age was 39.3 years). Agreement was moderate (weighted kappa = 0.52): compared with physician ratings, patient-rated severity was higher in 76 patients (11.2%), lower in 137 patients (20.2%), and matched in 465 patients (68.6%). There were no differences in the rates of agreement between physician and patient ratings based on physician specialty (p = 0.6781), objective severity measures [Eczema Area and Severity Index score (p = 0.5308), percent body surface area affected (p = 0.9872), and current systemic immunosuppressant use (p = 0.9197)]. Multivariate analysis showed patients with a worse quality of life (Dermatology Life Quality Index) were more likely to rate a higher severity (relative risk ratio 1.04, 95% confidence interval 1.00–1.08; p = 0.0460). Physicians were more likely to rate a higher severity with a greater physician-reported sleep disturbance (relative risk ratio 1.71, 95% confidence interval 1.01–2.89; p = 0.0440).ConclusionsAlmost one-third of patients rated atopic dermatitis severity differently from their physicians, supporting the importance of the patient perspective in the severity assessment of atopic dermatitis and the need for greater communication between patients and physicians.Electronic supplementary materialThe online version of this article (doi:10.1007/s40257-017-0284-y) contains supplementary material, which is available to authorized users.

Atopic dermatitis in adults: An Australian management consensus

“…Although there is limited information about how AD severity is actually rated by patients and physicians, there is a reported discrepancy between how physicians and patients rate the severity of AD: patients tend to focus more on skin‐related QoL outcomes while clinicians focus more on sleep disturbance . The Panel unanimously agreed that effective communication between patients and physicians should be encouraged to ensure the management of atopic dermatitis is directed towards the needs of the patient and that patient‐reported measures of disease severity are likely to be a useful adjunct to objective clinician assessment.…”

“…The report was provided to the panel, and a second round of voting was undertaken. Statements voted on in round 2 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) May 2018) were fewer and comprised re-phrased items for which there was either no consensus or for which wording clarification was suggested in round 1 voting. A further anonymised summary report was prepared after round 2 voting.…”

“…Although there is limited information about how AD severity is actually rated by patients and physicians, there is a reported discrepancy between how physicians and patients rate the severity of AD: patients tend to focus more on skin-related QoL outcomes while clinicians focus more on sleep disturbance. 14 The Panel unanimously agreed that effective communication between patients and physicians should be encouraged to ensure the management of atopic dermatitis is directed towards the needs of the patient and that patient-reported measures of disease severity are likely to be a useful adjunct to objective clinician assessment. The Panel further agreed that moderate-severe AD could also be defined based on the extent and severity of lesions and/or significant impact on QoL and that when determining disease severity, other qualifying situations that could be taken into account include lesion location (hands, face, genitals, scalp), frequency of flares and frequent hospital admissions due to flares.…”

Validation of the Atopic Dermatitis Control Tool (ADCT©) using a longitudinal survey of biologic-treated patients with atopic dermatitis

“…To confirm known-groups validity, mean ADCT total scores were compared across adjacent subgroups of patients based on PGAD responses (Excellent, Very good, Good, Fair, Poor) and categories of DLQI responses: no effect on patient life (score range: 0-1), a small effect (2-5), a moderate effect (6-10), a very large effect (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), an extremely large effect (21-30) [36] (Table 1). Patients in a worse PGAD or DLQI band subgroup were expected to display poorer AD control (i.e., higher mean ADCT total scores, indicating more severe symptoms/greater impact) than patients in a better PGAD or DLQI band subgroup.…”

“…Atopic dermatitis (AD) is a systemic, inflammatory skin condition [1,2] characterized by intense pruritus, eczematous lesions, swelling, and pain [3][4][5][6]. With increasing awareness of the substantial patient burden associated with long-term uncontrolled AD [3,[7][8][9][10][11][12][13], especially as it relates to sleep disturbance, quality of life, and work or school performance [6,[14][15][16][17][18][19], assessment of patient selfreported disease control has been deemed crucial for clinical evaluation of AD [15,20,21].…”