POOR QUALITY OF COMMUNICATION AMONG DIVERSE COHORT OF ADULTS WITH RHEUMATOID ARTHRITIS: RACE/ETHNICITY, LANGUAGE AND FATIGUE ASSOCIATED WITH RATINGS

 Purpose: To measure the quality of patient-clinician communication in a diverse cohort of adults with rheumatoid arthritis (RA).

Methods: Data were obtained through structured 30-minute telephone interviews conducted in English or Spanish. Subjects were enrollees of the Rheumatoid Arthritis Outcomes Study (RA OS), a longitudinal cohort of adults with RA. Two questions from the Consumer Assessment of Healthcare Providers and System (CAHPS) were used to assess RA patients' experience with communication with their rheumatologist. The questions were: “How often did this doctor check to make sure you understood everything?” and “How often did this doctor spend enough time with you?” Responses options consisted of 5 choices ranging from “never to always.” We report the proportion of subjects who responded “always” which is considered by CAHPS as the “Top-box” score. Logistic regression was used to model the quality of communication as a function of demographics (age, gender, race/ethnicity), education, insurance, health literacy (single-item literacy screener), English language proficiency, disease characteristics (duration, fatigue, comorbidities), and insurance.

Results: 395 adults with RA were surveyed with a mean age of 61 years, 89% were female, 46% white, 31% Latino. Nearly one-third (31%) had limited health literacy (LHL) and 17% had limited English language proficiency (LEP). Mean disease duration was 23 ± 12 years, 36% had one comorbidity, 21% had two or more; 39% reported moderate fatigue and 18% severe. There was a higher proportion of RA patients with LHL and LEP who reported that the rheumatologist “always” checked for understanding. In contrast, subjects with LEP, moderate and severe fatigue and of Latino ethnicity had a lower proportion responding that the doctor “always” spent enough time with them. Multivariate results in table.

Conclusion: RA patients with LEP reported that their rheumatologists checked for understanding more frequently than English proficient patients. However, LEP patients as well as Latinos and those with moderate to severe fatigue less frequently reported that doctors spend enough time with them. Providing high quality, patient-centered care in RA is important for all patients, especially those with barriers to communication.