Faculty Bibliography

Objective: To analyze discordance between global estimates by patients (PATGL) and their physicians (DOCGL) according to demographic and self-report variables on a multidimensional health assessment questionnaire (MDHAQ), in patients with many rheumatic diseases seen in usual care. Methods: Each patient completes an MDHAQ at each visit, which includes scores for physical function, pain and PATGL, each found on the HAQ, and scores for sleep quality, anxiety, depression, self-report joint count and fatigue, which are not found on the HAQ. A random visit of 980 patients with any rheumatic diagnosis was analyzed in 3 categories: PATGL=DOCGL (within 2/10 units); PATGL>DOCGL (by >/=2/10 units); DOCGL>PATGL (by >/=2/10 units), using descriptive statistics and multinomial logistic regression models. Results: Patients included 145 with rheumatoid arthritis, 57 systemic lupus erythematosus, 173 osteoarthritis, 348 other inflammatory, and 257 other non-inflammatory diseases. Overall, PATGL=DOCGL in 509 (52%), PATGL>DOCGL in 371 (38%) and DOCGL>PATGL in 100 (10%). PATGL>DOCGL was associated significantly with older age, female gender, low formal education, Hispanic ethnicity, not working, high MDHAQ physical function and pain, and high scores for fatigue, poor sleep, anxiety, depression, and self-report joint count, not available on the HAQ. Pain and fatigue were significant in a final multinomial logistic regression; the other variables may raise awareness of discordance to clinicians. Conclusions: Global estimates of patients indicated significantly poorer status than estimates of their physicians in 38% of 980 patients with rheumatic conditions, and were associated with demographic and MDHAQ scores, 5 of which are not available on the HAQ. (c) 2013 American College of Rheumatology.