FRI0614 Physician-patient interactions in african american patients with systemic lupus erythematosus
Authors: C. Drenkard, G. Bao, T. T. Lewis, B. F. Pobiner, J. Priest, S. S. Lim
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> African American (AA) patients with systemic lupus erythematosus (SLE) are at high risk for poor outcomes. Patient characteristics and disease severity influence physician-patient interactions, which in turn can impact outcomes. <h3>Objectives:</h3> Examine the relationships between physician-patient interactions and demographics, disease activity, and depression in AA SLE patients. <h3>Methods:</h3> The Georgians Organized Against Lupus (GOAL) is a population-based cohort of patients with a documented diagnosis of SLE. We conducted a cross-sectional analysis of patient-reported data among 698 AA participants (out of 863 GOAL participants). We assessed patients reports of physician-patient interactions (communication, patient-centered decision making, and physician interpersonal style) through the Interpersonal Processes of Care survey (IPC-29), disease activity through the Systemic Lupus Activity Questionnaire, and depression through the Patient Health Questionnaire-9. We used non-parametric tests to assess IPC-29 by demographics, linear trend test to assess demographic-adjusted scores of IPC-29 by disease activity and depression, and multivariate logistic regression to assess the association of disease activity and depression with suboptimal IPC scores. <h3>Results:</h3> Lowest IPC-29 scores were for patient-centered decision making, specifically for the "asked patient" subdomain (how often doctors assessed patients' problems to follow recommendations and treatment) in women compared with men (mean score 3.1±1.4 and 3.6±1.4, respectively; p=0.02). Scores for the "assumed socioeconomic level" subdomain (how often doctors make assumptions about a patient's socioeconomic level) in the interpersonal style domain were higher (worse) in patients aged 18–34 (mean score 1.6±0.9), compared to those aged 35–55 (mean score 1.5±0.9; p=0.03). Patients with higher educational attainment (≥college) reported poorer mean scores for most communication and interpersonal style scales than those with ≤high-school. We found significant linear trends of poorer scores for all communication scales across more severe disease activity and depression, and poorer scores for all interpersonal style scales across more severe disease activity. Neither disease activity nor depression was associated with worse patient-centered decision-making. In multivariate models depression was associated with suboptimal quality of communication (OR 1.2; 95% CI 1.04–1.4) and interpersonal style (OR 1.1; 95% CI 1.0–1.3); and disease activity increased the odds of suboptimal communication (OR 1.1; 95% CI 1.0–1.3). <h3>Conclusions:</h3> In AA patients with SLE, perceptions of physicians' communication, shared decision-making, and physicians' interpersonal style vary by sex and education. While disease activity and depression were associated with worse reports of physician-patient communication and interpersonal style, neither disease activity nor depression influenced shared-decision making. Our data suggest that in addition to standard of care treatment, AA SLE patients with active disease and depression might need provider-based interventions focused on communication and interpersonal style. <h3>Acknowledgements:</h3> Supported by Human Genome Science Inc. and GlaxoSmithKline (GHO-11–3366), and the Centers for Disease Control and Prevention (CDC-U01DP005119). <h3>Disclosure of Interest:</h3> C. Drenkard: None declared, G. Bao: None declared, T. Lewis: None declared, B. Pobiner Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, J. Priest Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, S. S. Lim: None declared