Evaluation of treatment satisfaction misalignment between Japanese psoriasis patients and their physicians – Japanese psoriasis patients and their physicians do not share the same treatment satisfaction levels

Figures & data

Table 1. Characteristics of subjects.

Patient characteristics
Number of patients (males, %)	425 (317, 74.6)
Age	56.5 ± 14.1 years
Disease duration from onset	18.7 ± 11.7 years
Affected sites (3 most frequent sites)	Leg (78.1%), head (70.4%), back (67.3%)
Body surface area	<1% (25.8%), 1–2% (21.8%), 3–10% (36.3%), >10% (16.1%)
Current treatment	Topical-dose drugs (82.6%), oral-dose drugs (52.9%), phototherapy (19.1%), biological agents (25.4%), other (1.4%)
Severity rating (patients’ GA: 0 − 5 scale)	2.55 ± 1.26
TSQM effectiveness	59.71 ± 18.64
TSQM side effects	92.88 ± 17.42
TSQM convenience	59.84 ± 16.40
TSQM global satisfaction	59.69 ± 18.23
Physician characteristics
Number of physicians (males, %)	70 (45, 64.3)
Age	50. 6 ± 11.7 years
Specialty	Psoriasis (69.6%), allergy (40.6%), other (41.8%)
Career in psoriasis treatment	<2 years (0.0%), 2–4 years (2.9%), 4–6 years (5.9%), 6–8 years (4.4%), 8–10 years (0.0%), ≥10 years (86.8%)
Number of patients managed/month	<5 (1.5%), 5–9 (5.9%), 10–14 (10.3%), 15–19 (7.4%), ≥20 (75.0%)
Severity rating (physicians’ GA: 0–5 scale)	2.51 ± 1.15

Values are shown as mean ± SD or n (%).

Abbreviations. GA, Global Assessment; TSQM, Treatment Satisfaction Questionnaire for Medication; SD, Standard deviation.

Figure 1. Distribution of patients’ (A, N = 423) and physicians’ (B, N = 423) treatment satisfaction. (A) Patients. (B) Physicians. Abbreviation. SD, Standard deviation.

Figure 2. Treatment satisfaction misalignment. Alignment, The difference of treatment satisfaction was within ±1 between the patient–physician pair; Misalignment, The absolute difference of treatment satisfaction was over 1 between the patient–physician pair; Patient predominant, Patients’ treatment satisfaction was at least 2 points higher than physicians’; Physician predominant, Physicians’ treatment satisfaction was at least 2 points higher than patients’.

Table 2. Patient characteristics in “physician-predominant” and “patient-predominant” groups (statistically significant variables).

Characteristics	Physician-predominant (N = 92)	Patient-predominant (N = 119)	p Value
Affected sites (genital area)	26 (28.26)	14 (11.76)	.002
Current treatment (phototherapy)	16 (17.39)	35 (29.41)	.043
Change of treatment goal setting from start of treatment, no change (%)	35 (38.04)	67 (56.78)	.007
Understanding level of treatment options	Well: 25 (27.17) Almost well: 61 (66.3) Neutral: 4 (4.35) Little: 2 (2.17) Never: 0 (0)	Well: 86 (72.27) Almost well: 32 (26.89) Neutral: 1 (0.84) Little: 0 (0) Never: 0 (0)	<.001
TSQM effectiveness	46.29 ± 15.89	63.96 ± 17.67	<.001
Physician’s sex, male (%)	72 (78.26)	77 (64.71)	.032
Physicians’ GA	2.38 ± 1.10	2.86 ± 0.97	.002
Physician’s most important reason for treatment satisfaction “treatment effectiveness”	31 (33.7)	12 (10.17)	<.001

Values are shown as mean ± SD or n (%).

Abbreviations. TSQM, Treatment Satisfaction Questionnaire for Medication; GA, Global Assessment; SD, Standard deviation.

Table 3. Factors associated with “physician-predominant” treatment satisfaction.

Factor	Odds ratio	Odds ratio 95% CI		p Value
		Lower bound	Upper bound
Symptoms in genital area	10.2	2.55	40.93	.001
Phototherapy	0.1	0.03	0.56	.006
No change of treatment goal setting from start of treatment	0.2	0.06	0.82	.025
Lack of understanding of treatment options	7.5	2.19	25.94	.001
TSQM effectiveness	0.9	0.84	0.94	<.001
Sex of physician (female vs. male)	0.2	0.04	0.87	.032
Physicians’ GA	0.3	0.13	0.54	<.001
Physicians’ most important reason for treatment satisfaction “treatment effectiveness”	35.5	5.43	231.78	<.001

Goodness of fit test (Hosmer–Lemeshow test): p = .8784.

Accurate discrimination rate (cut-off level = 0.50): 81.6%.

Abbreviations. GA, Global Assessment; TSQM, Treatment Satisfaction Questionnaire for Medication; CI, Confidence interval.

Pairs with incomplete answers about physician or patient treatment satisfaction (2 pairs) and treatment satisfaction aligned pairs (212 pairs) were excluded from the analysis. Pairs defective for any of the variables applied to the model (58 pairs) were excluded from the analysis.

Appendix 1. Major items included in the questionnaires of patients and physicians.

Category	Patient variable	Physician variable
1 Physician/patient background	• Sex	• Sex
	• Age	• Age
	• Complications	• Specialty
	• Smoking	• Treatment in the past
	• Alcohol intake	2–3 weeks, 3 and 6 months
	• Ambulatory care facility	• Rating of understanding of treatment options by patients, etc.
	• Treatment in the past 2–3 weeks, 3 and 6 months
	• Understanding of treatments choice, etc.
2 Severity evaluation	• Affected site
	• BSA (patient only)
	• Severity rating (Patient s’ GA/Physicians’ GA)
3 Treatment goals	• Treatment goal†	• Treatment goal†
	• Reason for treatment goal setting	• Reason for treatment goal setting
	• Obstacle to treatment	• Obstacle to treatment
	• Obstacle to treatment goal achievement, etc.
4 Treatment satisfaction and QOL	• Treatment satisfaction	• Treatment satisfaction
	• TSQM
	• DLQI

†Treatment goal: 1. complete clearance, 2. almost complete clearance, 3. complete clearance of difficult to treat sites (nails, head, genitals, others) but without complete or almost clearance for the remaining lesions, 4. improvement from previous treatment but without complete or almost clearance, 5. to relieve itching, 6. others and 7. no particular goal set.

Abbreviations. BSA, Body surface area; DLQI, Dermatology Life Quality Index (skin disease-specific QOL scale, high score means low QOL); GA, Global Assessment (severity assessment, high score means high severity); TSQM, Treatment Satisfaction Questionnaire for Medication (Treatment Satisfaction Scale, high score means high satisfaction); QOL, Quality of life.

Appendix 2. List of participating institutions.

Department of Dermatology, Asahikawa Medical University
Department of Dermatology, Jichi Medical University
Department of Dermatology, Tokyo Woman's Medical University
Department of Dermatology, School of Medicine, Teikyo University
Department of Dermatology, Tokyo Medical University
Department of Dermatology, School of Medicine, Tokai University
Department of Dermatology, Graduate School of Medicine, Gifu University
Graduate School of Medical Sciences, Nagoya City University
Department of Dermatology, School of Medicine, Kindai University
Department of Dermatology, Graduate School of Medicine, Osaka City University
Department of Dermatology, Kawasaki Medical School
Department of Dermatology, Faculty of Medicine, Fukuoka University
Department of Dermatology, Tokyo Teishin Hospital
Department of Dermatology, St Luke's International Hospital
Department of Dermatology, Yokohama Chuo Hospital
Public Interest Incorporated Foundation Jiai-kai, Branch of Imamura Hospital
Department of Dermatology, Ina Central Hospital
Department of Dermatology, Iida Municipal Hospital
Department of Dermatology, Osaka Kaisei Hospital
Medical Corporation Kojin-kai, Sapporo Dermatology Clinic
Medical Corporation Kojin-kai, Fukuzumi Dermatology Clinic
Kobayashi Skin Clinic
Department of Dermatology, EST Clinic
Sugawara Dermatology Clinic
Medical Corporation Subaru-kai, Sugai Dermatology Park Side Clinic
Hattori Dermatology Clinic
Medical Corporation Koten-kai, Iidabashi Clinic
Medical Corporation Shohei-kai, Niki Dermatology Clinic
Clinic of Dermatology, Ningyocho
Dr. Mariko Skin & Dermatology Clinic
Tsujimoto Skincare Clinic
Shirosaki Dermatology & Neurology Clinic
Kato Dermatology
Hou Dermatology
Machino Skin Clinique
Yasumoto Dermatology Clinic
Takagi Dermatology Clinic
Fushimi Skin Clinic
Omorimachi Dermatology
Hayashibe Derma Clinic
Hasegawa Dermatology Clinic
Medical Corporation Kojin-kai, Ario Sapporo Dermatology Clinic
Atago Dermatology
Medical Corporation Shotoku-kai, Hino Clinic
Nomura Dermatology Clinic
Zoshiki Dermatology Clinic
Nakatsu Dermatology Clinic
Saruwatari Dermatology Clinic
Kusuhara Dermatology Clinic
Medical Corporation Shimizu Dermatology Clinic
Kokubu Clinic, Abashiri Dermatology Clinic
Nishide Skin Clinic
Kazawa Skin Clinic
Shimizu Skin Clinic