Introduction. Preliminary studies found that discordance between the patients' and physicians' assessments of disease activity in systemic lupus erythematosus (SLE) exists. We investigated the factors associated with discordance and explored the impact of discordance on medication adherence and complementary/alternative medicine (CAM) use. / Methods. Part I investigated the factors associated with discordance, defined as the patient visual analog scale (VAS) minus the physician VAS for global disease activity. Data were extracted from the Montreal General Hospital Lupus Registry. Potential covariates included the Medical Outcomes Studies SF-36, the Systemic Lupus Activity Measure (SLAM), and a lupus damage index. The first visit data were analyzed using multiple regression. Unbalanced repeated measures analysis of variance was used to analyze follow-up data and to investigate the influence of time. / Part II used a patient questionnaire to measure adherence and CAM use, which was then linked to discordance data from the Registry. The associations between discordance and non-adherence and CAM use were tested using multivariable logistic regression. Non-linear relationships were tested by generalized additive models (GAM). / Results. Clinically important discordance occurred in nearly 30% of the visits. The SF-36 scales for Bodily Pain and Vitality were important variables for predicting discordance. SLAM-Skin and -Musculoskeletal components were also associated with discordance. The mean discordance tended to increase over time. While both the patients' and physicians' VAS scores tended to decrease over time, the decrease was more pronounced in the physicians' VAS scores. / Non-adherence and CAM use occurred in 32% and 55% of the subjects, respectively. Patients who scored much lower disease activity than their physicians were more likely to be non-adherent than concordant patients (odds ratio = 2.25, 95% confidence interval: 0.32, 15.96). GAM testing supported this finding. Odds ratios for discordance and use of CAM therapies ranged from 0.89 to 1.48 (all non-significant), and GAM showed a non-linear relationship represented by an inverted U-shaped curve. / Conclusion. Patient-physician discordance exists in SLE. Factors such as bodily pain and fatigue increase discordance while clinically visible signs, such as skin manifestations, reduce discordance. Clinically important discordance appears to be associated with patient self-care behaviour, particularly, medication nonadherence.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.38442 |
| Date | January 2001 |
| Creators | Yen, Jim C., 1967- |
| Contributors | Battista, Renaldo N. (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001861849, proquestno: NQ78803, Theses scanned by UMI/ProQuest. |
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