Perspectives on gastroesophageal reflux disease in primary care: the REFLEX study of patient-physician agreement

Background: Physicians may be unaware of the severity and extent of gastroesophageal reflux disease (GERD) in their patients. The aim of this study was to evaluate patient-physician agreement concerning proton pump inhibitor (PPI) treatment. Methods: 1818 French primary-care physicians and 5174 adult patients with GERD who were taking PPIs answered questions regarding symptoms and treatment satisfaction. Patient-physician agreement was scored using the Kappa (kappa) method. Results: There was moderate patient-physician agreement for PPI treatment satisfaction (kappa = 0.60), PPI prescription adherence (kappa = 0.57) and use of over-the-counter gastrointestinal medications (kappa = 0.44-0.51). Patient satisfaction with PPI therapy and PPI treatment adherence rates were both similar to 90%. There was poor patient-physician agreement concerning PPI therapy expectations (kappa = 0.22-0.33). Residual reflux symptoms occurred in 61% of patients. Physicians underestimated residual symptom severity compared with their patients (kappa = 0.43-0.47), though there was good agreement regarding the presence (kappa = 0.62-0.78) and frequency (kappa = 0.61-0.66) of these symptoms and their effect on patients' daily life (kappa = 0.64). Conclusions: Patient-physician agreement regarding PPI therapy for GERD was moderate or good for the presence of residual symptoms and moderate for treatment satisfaction, but poor for treatment expectations. PPI treatment resulted in high satisfaction rates, but residual symptoms were fairly common and their severity was underestimated by physicians.