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Patient use of weight-management activities: a comparison of patient and physician assessments.

ABSTRACT: Examine concordance between patient and physician assessments of patient self-reported use of weight-management activities.Analysis of baseline data from a randomized controlled trial of patient and physician interventions to improve patient-physician communication (41 physicians and 274 of their patients).A majority of patients reported regular exercise (55.6%) and efforts to lose weight, such as eating less (63.1%) while physicians only perceived one-third of patients as engaging in those activities (exercise, 36.6%; weight loss, 33.3%). Kappa scores indicated small agreement between patient and physician assessments of patient self-reported use of exercise, mean kappa 0.28 (range 0.15 to 0.40) and no agreement between patient and physician assessments of patient self-reported efforts to lose weight, mean kappa -0.14 (range -0.26 to -0.01). Obese patients were more likely than non-obese patients to report trying to lose weight or exercising regularly (p<0.05), but physicians were less likely to perceive obese patients as engaging in those activities (p<0.05).Primary care physicians differed considerably from their patients, especially obese patients, in their assessments of patient use of weight-management activities.These results highlight the importance of improving patient-provider communication about weight-management activities, particularly among obese patients.

SUBMITTER: Bleich SN

PROVIDER: S-EPMC2879463 | biostudies-other | 2010 Jun

REPOSITORIES: biostudies-other

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Patient use of weight-management activities: a comparison of patient and physician assessments.

Bleich Sara N SN Huizinga Mary Margaret MM Beach Mary Catherine MC Cooper Lisa A LA

Patient education and counseling 20100302 3

<h4>Objective</h4>Examine concordance between patient and physician assessments of patient self-reported use of weight-management activities.<h4>Methods</h4>Analysis of baseline data from a randomized controlled trial of patient and physician interventions to improve patient-physician communication (41 physicians and 274 of their patients).<h4>Results</h4>A majority of patients reported regular exercise (55.6%) and efforts to lose weight, such as eating less (63.1%) while physicians only perceiv ...[more]

PMID: 20193998

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Project description:ObjectiveTo assess the relationship between measures of disease assessment in patients with large vessel vasculitis.MethodsPatients with giant cell arteritis (GCA) or Takayasu arteritis (TAK) were recruited into a prospective, observational cohort. Assessments within the following outcomes were independently recorded: 1) patient-reported outcomes (Multidimensional Fatigue Inventory, patient global assessment of disease activity [PtGA], Short Form 36 health survey [SF-36], Brief Illness Perception Questionnaire), 2) physician global assessment of disease activity (PhGA), 3) laboratory outcomes (C-reactive protein [CRP] level, erythrocyte sedimentation rate [ESR]), and 4) imaging outcomes (PETVAS, a qualitative score of vascular 18 F-fluorodeoxyglucose-positron emission tomography activity).ResultsAnalyses were performed on 112 patients (GCA = 56, TAK = 56), over 296 visits, with a median follow-up of 6 months. Correlation network analysis revealed assessment measures clustered independently by type of outcome. PhGA was centrally linked to all other outcome types, but correlations were modest (ρ = 0.12-0.32; P < 0.05). PETVAS, CRP level, and PtGA were independently associated with clinically active disease. All 4 patient-reported outcomes strongly correlated with each other (ρ = 0.35-0.60; P < 0.0001). Patient-reported outcomes were not correlated with PETVAS, and only PtGA correlated with CRP level (ρ = 0.16; P < 0.01). Patients whose clinical assessment changed from active disease to remission (n = 29) had a corresponding significant decrease in ESR, CRP level, and PETVAS at the remission visit. Patients whose clinical assessment changed from remission to active disease (n = 11) had a corresponding significant increase in CRP level and PtGA at the active visit.ConclusionMeasures of disease assessment in large vessel vasculitis consist of independent, yet complementary, outcomes, supporting the need to develop composite outcome measures or a standard set of measures covering multiple types of outcomes.

Project description:Discordance between patient and physician ratings of rheumatoid arthritis (RA) severity occurs in clinical practice and correlates with pain scores and measurements of joint disease. However, information is lacking on whether discordance impacts patients' ability to work. We evaluated the discordance between patient and physician ratings of RA disease activity before and after treatment with etanercept and investigated the associations between discordance, clinical outcomes, and work productivity.In the PRESERVE clinical trial, patients with moderate RA received open-label etanercept 50 mg once weekly plus methotrexate for 36 weeks. Baseline and week-36 disease characteristics and clinical and work productivity outcomes were categorized according to week-36 concordance category, defined as positive discordance (patient global assessment - physician global assessment ?2), negative discordance (patient global assessment - physician global assessment???-2), and concordance (absolute difference between the two disease activity assessments?=?0 or 1). Correlations between discordance, clinical outcomes, and predictors of discordance were determined.At baseline, 520/762 (68.2 %) patient and physician global assessment scores were concordant, 194 (25.5 %) were positively discordant, and 48 (6.3 %) were negatively discordant. After 36 weeks of therapy, 556/763 (72.9 %) scores were concordant, 189 (24.8 %) were positively discordant, and 18 (2.4 %) were negatively discordant. Patients with week-36 concordance had the best 36-week clinical and patient-reported outcomes, and overall, the greatest improvement between baseline and week 36. Baseline pain, swollen joint count, duration of morning stiffness, fatigue, and patient general health significantly correlated with week-36 discordance, p?<?0.0001 to p?<?0.05. Additionally, baseline pain, patient general health, and C-reactive protein were predictors of week-36 discordance (odds ratios 1.22, 1.02, and 0.98, respectively). For the employed patients, percent impairment while working and percent overall work impairment were highest (greatest impairment) at baseline and 36 weeks in the group with positive discordance.The percentage of patients with concordance increased after 36 weeks of treatment with etanercept, with concordant patients demonstrating the greatest improvement in clinical and patient-reported outcomes. Discordance correlated with several measures of disease activity and was associated with decreased work productivity.ClinicalTrials.gov identifier: NCT00565409 . Registered 28/11/2007.

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Patient use of weight-management activities: a comparison of patient and physician assessments.

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Patient use of weight-management activities: a comparison of patient and physician assessments.

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