Divisão de Reumatologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
School of Medicine, Buenos Aires University and Argentine Rheumatologic Foundation Dr. Osvaldo Carcia Morteo, Buenos Aires, Argentina.
Clin Rheumatol. 2020 Jun;39(6):1813-1822. doi: 10.1007/s10067-019-04858-x. Epub 2020 Feb 7.
Discordance (misalignment) regarding treatment satisfaction may exist in real-life clinical practice between patients and their physicians. We aimed to assess physician and patient treatment satisfaction levels and associated degree of misalignment in rheumatoid arthritis (RA).
A point-in-time, multinational survey of patients and physicians was conducted in Latin America from December 2014 to October 2015. Physician- and patient-reported satisfaction levels with current RA treatment, alignment levels in satisfaction perception, and factors associated with satisfaction misalignment were assessed through bivariate and logistic regression analyses.
Participating physicians (N = 114) completed 555 patient record forms (PRFs); 372 patients completed self-complete questionnaires (PSC). A total of 346 physician-patient pairs were analyzed. Physicians reported satisfaction with current disease control in 270/346 (78.0%) PRFs; patients reported such satisfaction in 286/346 (82.7%) PSCs. Physician-patient alignment was observed in 78.6% of pairs. Compared with aligned patients, misaligned patients were younger, more likely to have moderate or severe disease (physician subjectively defined), deteriorating or unstable disease (physician subjectively defined), been exposed to a greater number of advanced therapy lines (biologic or Janus kinase inhibitor), greater current pain, a current acute episode, poorer health, and greater disability and impairment. Misaligned patients were less likely to be in remission. Logistic regression analysis revealed that misaligned patients were more likely to experience greater activity impairment.
High treatment satisfaction and alignment were observed among RA patients and their physicians in Latin America. Misaligned patients were more likely to report more severe disease and were less likely to be in remission. Addressing misalignment may lead to improved RA disease control.Key Points• High treatment satisfaction was observed among RA patients and their treating physicians in Latin America.• One-fifth of physician-patient pairs were misaligned in treatment satisfaction.• Patients misaligned with their physicians reported higher disease activity, lower quality of life, and greater disability than those who were aligned with their physicians.• Understanding and addressing misalignment in treatment satisfaction may improve outcomes in this patient population.
在现实临床实践中，患者及其医生之间可能存在关于治疗满意度的不一致（不匹配）。我们旨在评估类风湿关节炎（RA）患者和医生的治疗满意度水平及其相关的不匹配程度。
2014 年 12 月至 2015 年 10 月，在拉丁美洲进行了一项针对患者和医生的时点、多国调查。通过双变量和逻辑回归分析评估了医生和患者对当前 RA 治疗的满意度水平、满意度感知的匹配程度，以及与满意度不匹配相关的因素。
参与的医生（N=114）完成了 555 份患者病历表（PRF）；372 名患者完成了自我完成的问卷（PSC）。共分析了 346 对医生-患者。在 346 名 PRF 中，有 270 名医生报告对当前疾病控制满意；在 346 名 PSC 中，有 286 名患者报告对当前疾病控制满意。在 78.6%的配对中观察到医生-患者的匹配。与匹配的患者相比，不匹配的患者更年轻，更有可能患有中度或重度疾病（医生主观定义）、病情恶化或不稳定（医生主观定义）、接受过更多的先进治疗方案（生物制剂或 JAK 抑制剂）、当前疼痛更大、当前急性发作、健康状况更差，以及残疾和功能障碍更大。不匹配的患者更不可能处于缓解状态。逻辑回归分析显示，不匹配的患者更有可能经历更大的活动障碍。
在拉丁美洲，RA 患者及其医生的治疗满意度和匹配度都很高。不匹配的患者更有可能报告更严重的疾病，并且不太可能处于缓解状态。解决不匹配问题可能会改善 RA 的疾病控制。
在拉丁美洲，RA 患者及其治疗医生对治疗满意度较高。
五分之一的医生-患者对在治疗满意度方面存在不匹配。
与医生不匹配的患者报告疾病活动度更高、生活质量更低、残疾程度更大，而与医生匹配的患者则相反。
了解和解决治疗满意度方面的不匹配问题可能会改善该患者人群的治疗效果。
