Discordance of Global Estimates by Patients and Their Physicians in Usual Care of Many Rheumatic Diseases: Association With 5 Scores on a Multidimensional Health Assessment Questionnaire (MDHAQ) That Are Not Found on the Health Assessment Questionnaire (HAQ)
Discordance of Global Estimates by Patients and Their Physicians in Usual Care of Many Rheumatic Diseases: Association With 5 Scores on a Multidimensional Health Assessment Questionnaire (MDHAQ) That Are Not Found on the Health Assessment Questionnaire (HAQ)
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DOI：
10.1002/acr.22237
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发表时间：
2014-06-01
影响因子：
4.7
通讯作者：
Pincus, Theodore
中科院分区：
文献类型：
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作者：
Castrejon, Isabel;Yazici, Yusuf;Pincus, Theodore
目标。方法根据多维健康评估问卷(MDHAQ)中的人口学变量和自我报告变量，分析常见风湿性疾病患者的总体评估(PATGL)和医生评估(DOCGL)之间的不一致性。每个患者在每次就诊时都要完成一份MDHAQ，其中包括身体功能、疼痛和PATGL的分数，这些分数都可以在传统的健康评估问卷(HAQ)上找到，还有睡眠质量、焦虑、抑郁、自我报告关节计数和疲劳的分数，这些分数在HAQ上没有找到。采用描述性统计和多项Logistic回归模型，将980例风湿病患者随机分为3类：PATGL=DOCGL(2/10个单位)、PATGL>；DOCGL(2/10单位)和DOCGL>；PATGL(2/10单位)。患者包括类风湿性关节炎145例，系统性红斑狼疮57例，骨关节炎173例，其他炎症性疾病348例，其他非炎症性疾病257例。总体而言，PATGL=DOCGL 509例(52%)，PATGL>；DOCGL 371例(38%)，DOCGL>；PATGL 100例(10%)。PATGL>；DOCGL与高龄、女性、低学历、西班牙裔、不工作、高MDHAQ身体功能和疼痛评分以及疲劳、睡眠不佳、焦虑、抑郁和自我报告联合计数的高分数显著相关，这些在HAQ上是不存在的。疼痛和疲劳在最终的多项Logistic回归中显著；其他变量可能提高与临床医生不一致的意识。全球对患者的估计表明，在980名患有风湿病的患者中，38%的患者的状况比他们的医生估计的要差得多，这与人口统计和MDHAQ评分有关，其中5分在HAQ上不可用。
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 completed an MDHAQ at each visit, which includes scores for physical function, pain, and PATGL, each found on the traditional Health Assessment Questionnaire (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 of 10 units), PATGL>DOCGL (by >= 2 of 10 units), and DOCGL>PATGL (by >= 2 of 10 units), using descriptive statistics and multinomial logistic regression models.Results. Patients included 145 with rheumatoid arthritis, 57 with systemic lupus erythematosus, 173 with osteoarthritis, 348 with other inflammatory diseases, and 257 with other noninflammatory 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 sex, low formal education, Hispanic ethnicity, not working, high MDHAQ physical function and pain scores, and high scores for fatigue, poor sleep, anxiety, depression, and self-report joint count, which are 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.Conclusion. 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.