The relationship between patient and physician global assessment in patients with anti-neutrophil antibody associated vasculitis.

Abstract

Aim: To examine the level of agreement between the patient and physician global assessment (PtGA and PhGA) in patients with antineutrophil cytoplasmic antibody associated vasculitis (AAV). Background(s): 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. Method(s): 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. Result(s): 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. Conclusion(s): 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.