THE RELATIONSHIP BETWEEN PATIENT AND PHYSICIAN GLOBAL ASSESSMENT IN PATIENTS WITH ANTI-NEUTROPHIL ANTIBODY ASSOCIATED VASCULITIS

Mr Ajinkya Bhonsle¹, Dr Tim Coughlan¹, Miss Rachel Graven⁴, Mrs Paula Bussa¹, Dr Michael  Gingold^3,4, Dr   Kevan Polkinghorne^2,4, Dr Jessica  Ryan^2,4, Dr  A. Richard Kitching^2,4

¹Department of General Medicine, Monash Health, Clayton, Melbourne, Australia, ²Department of Nephrology, Monash Health, Clayton, Melbourne, Australia, ³Department of Rheumatology, Monash Health, Clayton, Melbourne, Australia, ⁴Department of Medicine, Monash University, Clayton, Melbourne, Australia

Aim

To examine the level of agreement between the patient and physician global assessment  (PtGA and PhGA) in patients with anti-neutrophil cytoplasmic antibody associated vasculitis (AAV).

Background

Patients with AAV have reduced health related quality of life (HRQoL), assessed by the SF-36 questionnaire. Global assessment provides a patient and physician’s view on the patient’s overall health and wellbeing.

Methods

Patients attending our dedicated tertiary vasculitis clinic were recruited into this prospective study. PtGA and PhGA scores, out of 100, were assessed via a visual analog scale, with higher scores representing better health. SF-36 assessed HRQoL. Discordance was defined as an absolute difference of ≥20 between PhGA and PtGA. Active disease was defined as a BVAS of ≥1.

Results

Ninety-seven patients (mean age 58 years, 46% male) participated. Forty-three (44%) patients had active disease. The majority (88%) were on immunosuppressive therapy and had renal involvement (79%). The mean (SD) PtGA and PhGA was 63.4 (22.2) and 60.8 (24.8) respectively (t=2.63, p=0.0049). Mean (SD) PtGA in active versus inactive disease was 59 (22.8) and 66 (21.5) respectively (t=1.49, p=0.07). PhGA scores were higher than PtGA in 44 patients with an overall mean difference of +13.7 (95% confidence interval [CI] 9.97, 17.46, p<0.001). PtGA scores were higher than PhGA in 48 patients (mean difference +17.9, 95% CI 22.6, 13.3, p<0.001). Scores were discordant in 26 patients, with PhGA>PtGA in 10 (38%). Bland-Altman plots showed no systematic bias as global scores increased.

Conclusions

Overall, physicians did not overestimate patients’ global health when using the global assessment tool. Discordance rates were 26%, within which, physicians were likelier to assess the patient’s global health lower than did patients themselves.

Biography:

I am a second year basic physician trainee at Monash Health with a keen interest in Nephrology and aim to pursue advanced training in this exciting specialty!