Satisfaction with patient-doctor relationships in inflammatory bowel diseases: Examining patient-initiated change of specialist

Table 1 Clinical and disease characteristics of inflammatory bowel diseases patients who responded to survey (n = 162)

Patient variable	n (%)
Female sex	85 (52.5)
Crohn’s disease	95 (58.6)
Ulcerative colitis	65 (40.1)
Previous bowel resection surgery (ever)	50 (30.9)
Recent inpatient admission1	80 (49.4)
Active disease2	69 (42.6)
Current stoma	19 (11.7)
Current perianal disease	29 (18.0)
Current cigarette smoker	31 (19.1)
Documented history of psychological comorbidity	41 (25.3)
Currently unable to work due to illness	39 (24.1)
Proportion of lowest socioeconomic group3	16 (9.9)

¹Inpatient admission in period between January 1, 2007-April 31, 2008;

²as determined by physician global assessment at time of survey completion;

³according to Social Health atlas, Central Northern Adelaide Health Service, Department of Health, SA 2004.

Table 2 Bivariable logistic regression analyses of relevant clinical and demographic factors potentially associated with a change in treating specialist

	Associated with change in treating specialist within 12 mo of survey completion		Associated with change in specialist for a "negative" reason at any time
Variable	OR [95% CI]	P value	OR [95% CI]	P value
Age under 30	1.13 [0.52, 2.47]5	0.015	0.60 [0.25, 1.46]	0.33
Female gender	1.15 [0.59, 2.24]	0.73	1.57 [0.71, 3.49]	0.31
Crohn’s as inflammatory bowel diseases diagnosis	2.03 [1.03, 4.03]5	0.045	0.79 [0.35, 1.78]	0.68
Recent inpatient admission3	1.70 [0.86, 3.35]5	0.135	0.82 [0.37, 1.82]	0.69
Previous bowel resection surgery1	3.23 [7.81, 1.41]5	0.0055	0.61 [0.27, 1.38]	0.28
Moderate/severe disease activity4	2.09 [1.06, 4.12]5	0.045	0.96 [0.43, 2.15]	0.93
Polypharmacy2	1.09 [0.51, 2.36]	0.85	1.50 [0.57, 3.97]	0.49
Living alone	1.06 [0.54, 2.07]	1.0	1.59 [0.71, 3.57]	0.31
Low socioeconomic status	1.62 [0.75, 3.48]	0.26	1.33 [0.53, 3.36]	0.66
Limited employment status	1.09 [0.52, 2.28]	0.85	0.65 [0.29, 1.49]	0.37
Poor inflammatory bowel diseases knowledge	0.39 [0.18, 0.88]5	0.035	2.04 [0.90, 4.55]5	0.125
Poor medication adherence	1.22 [0.62, 2.40]	0.60	2.22 [0.99, 4.95]5	0.065
Poor HRQoL	1.20 [0.57, 2.49]	0.71	0.91 [0.37, 2.24]	1.0
Possible psychological disorder (HADS > 7)	1.13 [0.58, 2.20]	0.74	0.75 [0.34, 1.68]	0.55
Dissatisfaction with medical care	0.95 [0.47, 1.90]	1.0	2.39 [1.05, 5.42]5	0.045

¹At any time in the past;

²taking ≥ 6 prescription medications currently;

³in observation period between January 1, 2007-April 31, 2008;

⁴as determined by physician global assessment at time of survey;

⁵items included in multivariate model (see Tables 3 and 4). OR: Odd ratio; 95% CI: 95% confidence interval; HADS: Hospital anxiety and depression scale; HRQoL: Health-related quality of life.

Table 3 Factors associated with change of treating specialist within 12 mo of survey completion - multivariable logistic regression analysis results

Variable	OR [95% CI]	P value
Crohn’s disease as IBD diagnosis	2.60 [1.25, 5.41]	0.01
Age1	0.98 [0.97, 0.99]	0.01
Previous bowel resection surgery2	5.56 [1.92, 16.67]	0.002
Recent inpatient admission3	1.97 [1.29, 3.01]	0.002
Moderate/severe disease activity4	2.16 [0.99, 4.71]	0.05

¹For every one year increase in age;

²at any time in the past;

³within observation period between 2007-April 31, 2008;

⁴as determined by physician global assessment at time of survey. OR: Odd ratio; 95% CI: 95% confidence interval; IBD: Inflammatory bowel diseases.

Table 4 Factors associated with change in specialist for a negative reason - multivariable logistic regression analysis results

Variable	OR [95% CI]	P value
Female gender1	0.36 [0.13, 1.01]	0.053
Suboptimal satisfaction with medical care	1.22 [0.40, 3.75]	0.73
Poor disease knowledge	0.54 [0.20, 1.50]	0.24
Poor medication adherence1	3.49 [1.12, 10.89]	0.03

¹Variables indicate those statistically, significantly associated with a negative reason for change in specialist. OR: Odd ratio; 95% CI: 95% confidence interval.