(PS1-89) How Does the Match Between Veterans’ with Gulf War Illness and Providers’ Perception of Concordance Affect Future Patient Satisfaction and Treatment Adherence?

The current study examined how the match between Veterans with Gulf War Illness (GWI) and specialty providers’ perceptions of concordance about GWI affect Veterans’ treatment satisfaction and adherence to treatment recommendations. GWI is a chronic multisymptom illness with disabling “medically unexplained” persistent physical symptoms (e.g., chronic fatigue, pain). Care for GWI is characterized by discordance between Veterans and providers about the nature of GWI (i.e., illness perceptions). Quantitative and qualitative research has found Veteran’s perceptions of concordance, or the process in which the Veteran and provider come to a shared understanding about GWI illness perceptions is associated with better Veteran health outcomes. This study sought to extend this research to examine both Veterans’ and providers’ perceptions of concordance. We hypothesized that a stronger match between the Veterans’ and providers’ perceived concordance after the first appointment would be associated with greater Veteran adherence to treatment recommendations and greater Veteran satisfaction 1 week, 1 month, and 6 months after the first appointment. Participants were 83 Veteran-provider dyads that were part of a larger longitudinal mixed methods observational prospective study that examined primary and tertiary care for GWI. In tertiary care, Veterans received a multi-day comprehensive evaluation of GWI by the care team (i.e., physician, occupational and environmental medicine, neuropsychology, social work). Veteran participants were recruited from the VA tertiary referral center with three locations (California, New Jersey, and Washington D.C.). Provider participants were the tertiary clinic providers who conducted the Veterans’ health and physical evaluation. A series of polynomial regressions examined how the convergence and divergence of the Veterans’ and providers’ self-reported concordance perceptions were associated with satisfaction and treatment adherence 1 week, 1 month, and 6 months after meeting. All models covaried for the Veterans’ GWI illness perceptions. Results indicated that Veterans’ perceptions of concordance were associated with satisfaction at 1 week (p < .001), 1 month (p < .001), and 6 months (p = .02). Veterans’ perceptions of concordance was associated with adherence to recommendations at one week (p = .01), while adherence to recommendations at 1 month and 6 months were not statistically significant. The association between providers’ perception of concordance and the interaction of the provider and Veteran concordance with both satisfaction and adherence were not significant at any timepoint. These findings suggest that the Veteran’s perception of concordance may be an important predicter of patient outcomes. Although providers are involved in the process of concordance, their perceptions of concordance may not influence Veterans’ satisfaction or adherence to treatment recommendations. Future research should continue to focus on Veterans’ perception of concordance.