(1205) Confidence in Patient-doctor Interactions Among Patients with Atrial Fibrillation and Psychiatric Multimorbidity

Objectives: Atrial fibrillation (AF) is the most common heart arrhythmia and affects over 5 million adults in the US. Among those living with AF almost 40% live with co-occurring depression, anxiety or cognitive impairment. Medical treatment to prevent any long-term heart complications related to AF can consist of cardioversion, catheter procedures or medication therapy, which is often lifelong. Management of AF is complex and successful management requires active patient engagement in treatment decisions and confidence in patient-physician interactions. While there is evidence that patients with depression or anxiety report lower confidence in patient-physician interactions, the relationship between psychiatric multimorbidity (the presence of 2 or more psychiatric impairments) in patients with AF and their confidence in interactions with physicians remains unclear. The objective of this study is to examine factors related to lower confidence in patient-physician interactions and determine whether confidence in patient-physician interactions differs among patients with AF and psychiatric multimorbidity.

Methods: Older adults (aged ≥65 years) with AF who were eligible for oral anticoagulation therapy and had a CHA2DS2VASC risk scores ≥2, were recruited from five medical centers in Massachusetts and Georgia between 2015-2018. Psychiatric multimorbidity was defined as the presence of 2 or more psychiatric conditions using validated measures (depression: Patient Health Questionnaire-9; anxiety: Generalized Anxiety Disorder-7 scale; and cognitive impairment: Montreal Cognitive Assessment Battery). Confidence in patient-physician interactions was measured using the ten item Perceived Efficacy in Patient-Physician Interaction Questionnaire (PEPPI). Each question was scored on a scale of 1 (not at all confident) to 10 (very confident) with a possible score range of 10-100. Patient demographic and clinical characteristics were abstracted from electronic medical records. Data will be analyzed using analysis of variance, χ2 and t-tests to compare characteristics across confidence in patient-physician interactions. Multiple logistic regression will be used to examine the association between psychiatric multimorbidity and lower confidence in patient-physician interactions.

Results: Among 1,244 participants (49% female; average 76±7 years; 86% non-Hispanic white), the majority of participants (N = 755, 61 %) had at least one psychiatric impairment. By impairment, 6.3% of participants had depression, 4.1% of participants had anxiety, and 25.1% of participants had cognitive impairment. Approximately 35% of participants had one impairment, 17% of participants had two impairments, 8% of participants had all three impairments, and 39% had none of the three impairments. Approximately 33% of participants reported lower confidence patient-physician interactions compared to about 64% who reported higher confidence. Further data regarding the associations between psychiatric multimorbidity and confidence in patient-physician interactions will be analyzed before March 1, 2024 and will be presented at the APhA annual meeting.

Conclusions: Understanding factors associated with lower confidence in patient-physician interactions and how psychiatric multimorbidity affects confidence may identify a population at greater risk for nonadherence to treatment. As pharmacist-led shared decision making initiatives lead to improved adherence, patient understanding and treatment satisfaction, pharmacists may be uniquely positioned to engage in and support the shared decision making process in patients with psychiatric multimorbidity and lower confidence in patient-physician interactions.