Doctors not often overly rosy in views of overall health with AAV
Study pairs assessments made by patients with those of their physicians
Physicians typically do not overestimate the overall health of people with ANCA-associated vasculitis (AAV), a study of global assessments made by patients and their doctors in Australia reports. In cases where ratings between these two groups markedly differed, doctors tended to assign a lower score than did the people evaluating their own health.
“To our knowledge, our study is the first in patients with AAV to compare [patient and physician global assessments of] overall health,” the researchers wrote. “Overall health, while influenced by disease activity, is also influenced by damage, medication, psychosocial factors, and comorbidities” or co-occurring conditions.
The study, “Relationships between patient and physician global assessments in anti-neutrophil cytoplasmic antibody-associated vasculitis,” was published in Clinical Rheumatology.
Global health assessments can be useful tools in doctor-patient relationships
Both patients and doctors use global assessment tools, or scales, to measure disease activity and overall health, or changes in either. These tools can be helpful with communication between the two groups, and in spotlighting differences in patient and doctor views of a person’s health status.
Researchers, mostly with Monash University, looked at how doctors and their patients compare in the way they score overall health using global assessment tools. It also explored why these scores may differ. A difference of 20 points or more between the two scores was considered “discordant” by the scientists.
Ninety-seven patients, mostly female (53.6%) with an average age of 58, took part in the study. Most (88%) were being treated with immunosuppressants, and most (79%) had kidney involvement. A majority were diagnosed with microscopic polyangiitis (52.6%), the most common type of AAV, followed by granulomatosis with polyangiitis (44.3%), and eosinophilic granulomatosis with polyangiitis (3.1%).
Patients assessed their overall health prior to a visit with their doctor, with responses ranging from very poor to excellent being converted to scores ranging from zero to 100. Doctors, without knowing the patient’s score, also rated the person’s overall health with a similar score conversion; using other tools, they rated disease activity and chronic disease-related damage.
On average, patients and doctors showed general agreement in their global health assessments, with a mean score of 63.4 score among patients and 60.8 among physicians. Doctors gave a poorer overall health rating to people with active disease (54 points; 48 patients were seen to be in this state) than they did to those with inactive disease (66.2 points).
These physicians rated the overall health of 44 people higher than the patients did, for a mean difference of 13.7 points. In turn, 48 patients rated their overall health higher than did their doctors, with a mean difference of 17.9 points.
Differences of 20 or more points can be tied to more positive patient scores
Discordance, or a difference of 20 points or more between patient-doctor assessment scores, was observed in about one-quarter (26.8%) of the patients, a “significant minority,” the researchers noted. The 10 people whose assessments fell below those of their physicians were older, had less active disease, and were more likely to be immunosuppressed than the 16 with overall health assessment scores higher than those of their doctors.
“Interestingly, patient characteristics between discordant and nondiscordant patients were similar, which poses the question as to whether there are unmeasured factors that account for the difference,” the team wrote.
For both patients and doctors, global assessment measures correlated, or went hand in hand, with the 36-Item Short Form Health Survey, a measure of health-related quality of life commonly used in clinical practice.
This study “suggests that [patient and doctor global assessment] may be used as a brief, easily administered assessment of [health-related quality of life] in people with AAV,” the researchers concluded. They placed importance on findings indicating that doctors do not overestimate patients’ overall health on global assessments, and score discordance between the two groups being “present in a minority of patients.”
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