Physician-patient agreement at a rheumatology consultation - construction and validation of a consultation assessment instrument

Objectives: After consultations, the physician's perceptions differ from the patient's perceptions concerning illness level, cause and nature of the problem and content of the consultation. Agreement on problems requiring follow-up has been associated with a better outcome. The primary aim of this study was to build and validate an instrument that assesses physician-patient agreement in the rheumatology consultation. The secondary objective was to assess agreement association with patient's clinical and sociodemographic data. Materials and Methods: A ten-item questionnaire - "Consultation Assessment Instrument" (CAI) - was developed for this study to assess physician-patient agreement. Ten physicians and 102 patients diagnosed with an inflammatory joint disease under biological therapy were included. The items were evaluated and the index of proportional agreement for the dichotomized answers "agree" (Ppos) and "disagree" (Pneg) was calculated. Results: Consultation satisfaction was the item with the highest agreement. On the opposite end, the item about the explanation of treatment importance was the item with the lowest agreement between patient and physician. Except for one item, the high level of agreement between patient and physician was due to a higher Ppos. Index of proportional agreement was high for 9 of the 10 items (0.816 <= Iv <= 0.990). Patients with lower disease activity scores had a more positive experience. A good internal consistency was obtained for both patient's and physician's questionnaire (alpha= 0.88 and alpha= 0.80, respectively). Conclusions: Both patient and physician showed a positive experience towards rheumatology consultation. Physician-patient agreement was high in the majority of the consultation aspects (mean I-v = 0,93). A good internal consistency was obtained for both patient's and physician's questionnaire. CAI may be useful as a mental checklist in daily practice or as an educational tool for training consultation skills.