Predictors of perceived higher quality patient-provider communication in patients with rheumatoid arthritis.

Untreated rheumatoid arthritis (RA), an inflammatory autoimmune disease affecting approximately 1% of the U.S. population, can result in joint pain and damage, leading to joint dysfunction and ultimately, disability (American College of Rheumatology Subcommittee, 2002; Helmick et al., 2008). The World Health Organization (WHO) International Classification of Functioning, Disability, and Health is a globally-accepted, biopsychosocial model of disability (Stucki & Cieza, 2004; WHO, 2002). In this model “disability is always an interaction between features of the person and features of the overall context in which the person lives” (WHO, 2002, p. 9). The model included contextual factors (environmental and personal) that impact activity, body function and structure, and participation. An example of an external environmental factor is the geographic location where a person resides (WHO, 2002). Examples of internal personal factors include gender, age, and level of education (WHO, 2002). Within the model, there are eight separate components of body function and structure; nine components of activities and participation; and five environmental factors. Communication is one of the nine components of activities described in the International Classification of Functioning, Disability, and Health (WHO, 2002). This model also has disease-specific Core Sets. Core sets are disease-specific International Classification of Functioning, Disability and Health categories to be used when reporting patient functioning and health (Stucki & Cieza, 2004). Communication is one component of the Core Set for RA (Stucki & Cieza, 2004). There is concordance between the importance placed on communication in the International Classification of Functioning, Disability and Health and that reported in prior research in patients with RA. Lempp and colleagues (2006) reported that high quality patient-health care provider communication is essential to the provision of effective RA care. Although there are established negative psychosocial effects of RA (e.g. employment restrictions, depression), the relationship between these effects and patient-provider communication is not well studied (Gafvels, Hagerstrom, Nordmark, Wandell, 2012). The few existing studies found that effective communication promoted the development of a trusting patient-health care provider relationship, improved health outcomes, decreased grievances to medical regulatory authorities, facilitated optimal care, and improves adherence to prescribed medications (Berrios-Rivera et al., 2006; Fair, 2003; Tamblyn et al., 2007; Viller et al., 1999; Wolfe, 1995). Patient involvement in decision-making, the use of common, easily understood health terms by the provider, and the involvement of community leaders may improve patient-provider communication (Fagerlind, Ring, Brulde, Feltelius, & Lindblad, 2010; Hainsworth & Barlow, 2001; Ishikawa, Hashimoto, & Yano, 2006). Inadequate patient-health care provider communication is a barrier to optimal RA patient care (Bernatsky et al., 2010). Some issues with communication include lack of adequate time for communication and inadequate patient access to providers (Bernatsky et al., 2010). Few environmental or personal factors have been investigated to determine their association with patient-provider communication in patients with RA. Traylor and colleagues (2010) found that Caucasian patients with higher incomes were 2.5 to 2.3 times respectively, more likely to have a discussion with their health care provider about the cost of their medications. When reviewing the literature outside of the RA population, Carcaise-Edinboro and Bradley (2008) also found that patient-provider communication affected rates of colorectal cancer screening and that perception of communication quality differed between races and ethnicities. Thus, there is a significant gap in our understanding about those contextual factors (environmental and personal) that influence patient perception of higher quality patient-provider communication in patients with RA (Repping-Wuts et al., 2009). The identification of contextual factors associated with higher quality patient-provider communication could be instrumental to the development of targeted interventions to improve the efficacy of patient-provider communication, and subsequent outcomes. Thus, the purpose of this study was to evaluate contextual factors associated with patient-perceived quality of patient-provider communication in a group of patients with RA. The specific aims of the study were: 1) to compare internal personal factors (gender, age, race, education, employment status, marital status, duration of disease, and number of medications) and an external environmental factor (urban/rural residence) of individuals who perceived higher quality patient-provider communication with those who perceived lower quality; and 2) to evaluate the predictive power of internal personal factors (gender, age, race, education, employment status, marital status, duration of disease, and number of medications) and an external environmental factor (urban/rural residence) for higher quality patient-health care provider communication.