Charmaine Tze May Wang1, Warren Fong1,2,3, Yu Heng Kwan4, Jie Kie Phang1, Nai Lee Lui1, Ying Ying Leung1, Julian Thumboo1,2,3, Peter P Cheung3,5. 1. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore. 2. Duke-NUS Medical School, Singapore City, Singapore. 3. Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore City, Singapore. 4. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore City, Singapore. 5. Division of Rheumatology, National University Hospital, Singapore City, Singapore.
Abstract
AIM: To identify the factors associated with patient-physician discordance in patients with axial spondyloarthritis (axSpA) in an Asian population. METHODS: A cross-sectional study was conducted in two tertiary referral centers in Singapore. Patients with axSpA who fulfilled Assessment in Ankylosing Spondylitis International Working Group 2009 criteria for axSpA were included in the study. Socio-demographics, clinical, laboratory and patient-reported outcomes data were collected during study visits from 2014 to 2015. We performed univariate and multivariate linear regression analyses to evaluate the factors associated with patient-physician discordance, which we defined as the difference between Patient Global Assessment and Physician Global Assessment. RESULTS: Included in the study were 298 axSpA patients: 82% male, 81% Chinese, median age 40 (20-78) years, median disease duration 9 (0.1-48) years. 80% were on non-steroidal anti-inflammatory drugs and 23% on biologics. In univariate analysis, current age (β: 0.18, ρ = 0.06), duration of disease (β: 0.34, ρ = 0.03), post-secondary education level (β: -10.82, ρ = 0.03), global pain score (β: 0.33, ρ < 0.01), Bath Ankylosing Spondylitis Functional Index (β: 2.80, ρ < 0.01), Ankylosing Spondylitis Disease Activity Score C-reactive protein (β: 4.63, ρ < 0.01) and current use of biologics (β: 10.97, ρ < 0.01) were associated with patient-physician discordance. In multivariate analysis, global pain score (β: 0.32, ρ < 0.01), post-secondary education level (β: -12.80, ρ = 0.01) and current biologics use (β: 16.21, ρ < 0.01) were associated with patient-physician discordance. CONCLUSION: Higher global pain score, lower educational level and current biologics use were associated with greater patient-physician discordance. These factors should be considered during shared decision making.
AIM: To identify the factors associated with patient-physician discordance in patients with axial spondyloarthritis (axSpA) in an Asian population. METHODS: A cross-sectional study was conducted in two tertiary referral centers in Singapore. Patients with axSpA who fulfilled Assessment in Ankylosing Spondylitis International Working Group 2009 criteria for axSpA were included in the study. Socio-demographics, clinical, laboratory and patient-reported outcomes data were collected during study visits from 2014 to 2015. We performed univariate and multivariate linear regression analyses to evaluate the factors associated with patient-physician discordance, which we defined as the difference between Patient Global Assessment and Physician Global Assessment. RESULTS: Included in the study were 298 axSpA patients: 82% male, 81% Chinese, median age 40 (20-78) years, median disease duration 9 (0.1-48) years. 80% were on non-steroidal anti-inflammatory drugs and 23% on biologics. In univariate analysis, current age (β: 0.18, ρ = 0.06), duration of disease (β: 0.34, ρ = 0.03), post-secondary education level (β: -10.82, ρ = 0.03), global pain score (β: 0.33, ρ < 0.01), Bath Ankylosing Spondylitis Functional Index (β: 2.80, ρ < 0.01), Ankylosing Spondylitis Disease Activity Score C-reactive protein (β: 4.63, ρ < 0.01) and current use of biologics (β: 10.97, ρ < 0.01) were associated with patient-physician discordance. In multivariate analysis, global pain score (β: 0.32, ρ < 0.01), post-secondary education level (β: -12.80, ρ = 0.01) and current biologics use (β: 16.21, ρ < 0.01) were associated with patient-physician discordance. CONCLUSION: Higher global pain score, lower educational level and current biologics use were associated with greater patient-physician discordance. These factors should be considered during shared decision making.
Authors: Fumio Hirano; Robert B M Landewé; Floris A van Gaalen; Désirée van der Heijde; Cécile Gaujoux-Viala; Sofia Ramiro Journal: Arthritis Care Res (Hoboken) Date: 2022-01-13 Impact factor: 5.178