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American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 6/2017

Open Access 01-12-2017 | Original Research Article

Discordance Between Physician- and Patient-Reported Disease Severity in Adults with Atopic Dermatitis: A US Cross-Sectional Survey

Authors: Wenhui Wei, Peter Anderson, Abhijit Gadkari, Stuart Blackburn, Rachel Moon, James Piercy, Shashank Shinde, Jorge Gomez, Eric Ghorayeb

Published in: American Journal of Clinical Dermatology | Issue 6/2017

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Abstract

Background

There is limited understanding of severity rating of atopic dermatitis in clinical practice.

Objectives

To evaluate the agreement between physician- and patient-rated severity of atopic dermatitis.

Methods

Data were collected from the 2014 Adelphi US Atopic Dermatitis Disease Specific Programme, a cross-sectional survey of physicians and their patients with a history of moderate-to-severe atopic dermatitis; patients voluntarily completed a questionnaire. Current disease severity (mild/moderate/severe), based on personal judgment, was rated independently by patients and their physicians. The weighted kappa statistic identified level of agreement between physicians and patients. Bivariate analyses characterized agreement; multi-nomial logistic regression identified factors associated with discordance.

Results

Overall, 678 patients were included (369 [54.4%] were women, 525 [77.4%] were White, mean age was 39.3 years). Agreement was moderate (weighted kappa = 0.52): compared with physician ratings, patient-rated severity was higher in 76 patients (11.2%), lower in 137 patients (20.2%), and matched in 465 patients (68.6%). There were no differences in the rates of agreement between physician and patient ratings based on physician specialty (p = 0.6781), objective severity measures [Eczema Area and Severity Index score (p = 0.5308), percent body surface area affected (p = 0.9872), and current systemic immunosuppressant use (p = 0.9197)]. Multivariate analysis showed patients with a worse quality of life (Dermatology Life Quality Index) were more likely to rate a higher severity (relative risk ratio 1.04, 95% confidence interval 1.00–1.08; p = 0.0460). Physicians were more likely to rate a higher severity with a greater physician-reported sleep disturbance (relative risk ratio 1.71, 95% confidence interval 1.01–2.89; p = 0.0440).

Conclusions

Almost one-third of patients rated atopic dermatitis severity differently from their physicians, supporting the importance of the patient perspective in the severity assessment of atopic dermatitis and the need for greater communication between patients and physicians.
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Metadata
Title
Discordance Between Physician- and Patient-Reported Disease Severity in Adults with Atopic Dermatitis: A US Cross-Sectional Survey
Authors
Wenhui Wei
Peter Anderson
Abhijit Gadkari
Stuart Blackburn
Rachel Moon
James Piercy
Shashank Shinde
Jorge Gomez
Eric Ghorayeb
Publication date
01-12-2017
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 6/2017
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.1007/s40257-017-0284-y

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