{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:22:50Z","timestamp":1791501770538,"version":"4.3.4"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"Importance<\/jats:title>Patients and physicians often have differing opinions on the patient\u2019s disease severity. This phenomenon, termed discordant severity grading<\/jats:italic> (DSG<\/jats:italic>), hinders the patient-physician relationship and is a source of frustration.<\/jats:p><\/jats:sec>Objective<\/jats:title>To test and validate a model explaining the cognitive, behavioral, and disease factors associated with DSG.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A qualitative study was first performed to derive a theoretical model. In this subsequent prospective cross-sectional quantitative study, the qualitatively derived theoretical model was validated using structural equation modeling (SEM). Recruitment was conducted between October 2021 and September 2022. This was a multicenter study in 3 Singapore outpatient tertiary dermatological centers. Dermatology patients and their attending physicians were recruited by convenience sampling. Patients were aged 18 to 99 years with psoriasis or eczema of at least 3 months\u2019 duration and recruited only once. The data were analyzed between October 2022 to May 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The outcome was the difference between global disease severity (0-10 numerical rating scale with a higher score indicating greater severity) as independently scored by the patient and the dermatologist. Positive discordance was defined as patient-graded severity more than 2 points higher (graded more severely) than physicians, and negative discordance if more than 2 points lower than physicians. Confirmatory factor analysis followed by SEM was used to assess the associations between preidentified patient, physician, and disease factors with the difference in severity grading.<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 1053 patients (mean [SD] age, 43.5 [17.5] years), a total of 579 (55.0%) patients were male, 802 (76.2%) had eczema, and 251 (23.8%) had psoriasis. Of 44 physicians recruited, 20 (45.5%) were male, 24 (54.5%) were aged between 31 and 40 years, 20 were senior residents or fellows, and 14 were consultants or attending physicians. The median (IQR) number of patients recruited per physician was 5 (2-18) patients. Of 1053 patient-physician pairs, 487 pairs (46.3%) demonstrated discordance (positive, 447 [42.4%]; negative, 40 [3.8%]). Agreement between patient and physician rating was poor (intraclass correlation, 0.27). The SEM analyses showed that positive discordance was associated with higher symptom expression (standardized coefficient B\u2009=\u20090.12; P<\/jats:italic>\u2009=\u2009.02) and greater quality-of-life impairment (B\u2009=\u20090.31; P<\/jats:italic>\u2009&amp;lt;\u2009.001), but not patient or physician demographics. A higher quality-of-life impairment was in turn associated with lower resilience and stability (B\u2009=\u2009\u22120.23; P<\/jats:italic>\u2009&amp;lt;\u2009.001), increased negative social comparisons (B\u2009=\u20090.45; P<\/jats:italic>\u2009&amp;lt;\u2009.001), lower self-efficacy (B\u2009=\u2009\u22120.11; P<\/jats:italic>\u2009=\u2009.02), increased disease cyclicity (B\u2009=\u20090.47; P<\/jats:italic>\u2009&amp;lt;\u2009.001), and greater expectation of chronicity (B\u2009=\u20090.18; P<\/jats:italic>\u2009&amp;lt;\u2009.001). The model was well-fitted (Tucker-Lewis: 0.94; Root Mean Square Error of Approximation: 0.034).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cross-sectional study identified various modifiable contributory factors to DSG, increased understanding of the phenomenon, and set a framework for targeted interventions to bridge this discordance.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.2008","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T15:01:54Z","timestamp":1689174114000},"page":"811","source":"Crossref","is-referenced-by-count":37,"title":["Understanding Discordant Perceptions of Disease Severity Between Physicians and Patients With Eczema and Psoriasis Using Structural Equation Modeling"],"prefix":"10.1001","volume":"159","author":[{"given":"Valencia","family":"Long","sequence":"first","affiliation":[{"name":"Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaojin","family":"Chen","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore"},{"name":"Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruochen","family":"Du","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiong Huak","family":"Chan","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yik Weng","family":"Yew","sequence":"additional","affiliation":[{"name":"Dermatology, National Skin Centre, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel H.","family":"Oon","sequence":"additional","affiliation":[{"name":"Dermatology, National Skin Centre, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Thng","sequence":"additional","affiliation":[{"name":"Dermatology, National Skin Centre, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur Qasrina Binte Iskandar","family":"Lim","sequence":"additional","affiliation":[{"name":"Research Unit, Department of Medicine, National University Healthcare System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Tan","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha Suyien","family":"Chandran","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Valderas","sequence":"additional","affiliation":[{"name":"Centre for Research in Health System Performance, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"},{"name":"Department of Family Medicine, National University Healthcare System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Phan","sequence":"additional","affiliation":[{"name":"Carey Business School, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellie","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore"},{"name":"Centre for Research in Health System Performance, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"key":"doi230026r1","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.ejim.2022.11.010","article-title":"Discordance in perception of disease severity between patient and physicians.","volume":"109","author":"Long","year":"2023","journal-title":"Eur J Intern Med"},{"issue":"2","key":"doi230026r2","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1002\/acr.v67.2","article-title":"Factors explaining the discrepancy between physician and patient global assessment of joint and skin disease activity in psoriatic arthritis patients.","volume":"67","author":"Eder","year":"2015","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"6","key":"doi230026r3","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1007\/s40257-017-0284-y","article-title":"Discordance between physician- and patient-reported disease severity in adults with atopic dermatitis: a US cross-sectional survey.","volume":"18","author":"Wei","year":"2017","journal-title":"Am J Clin Dermatol"},{"issue":"2","key":"doi230026r4","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2017-000551","article-title":"Discordant patient-physician assessments of disease activity and its persistence adversely impact quality of life and work productivity in US Hispanics with rheumatoid arthritis.","volume":"3","author":"Karpouzas","year":"2017","journal-title":"RMD Open"},{"issue":"2","key":"doi230026r5","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1111\/jdv.2012.26.issue-2","article-title":"Disease severity evaluation among dermatological out-patients: a comparison between the assessments of patients and physicians.","volume":"26","author":"Tabolli","year":"2012","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"6","key":"doi230026r6","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1002\/acr.20132","article-title":"Patient-physician discordance in assessments of global disease severity in rheumatoid arthritis.","volume":"62","author":"Barton","year":"2010","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"1","key":"doi230026r7","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.jaad.2010.05.001","article-title":"Comparison of patients\u2019 and providers\u2019 severity evaluation of oral mucosal conditions.","volume":"65","author":"Sampogna","year":"2011","journal-title":"J Am Acad Dermatol"},{"issue":"4","key":"doi230026r8","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1001\/jamadermatol.2020.5844","article-title":"Association of patient mental health status with the level of agreement between patient and physician ratings of psoriasis severity.","volume":"157","author":"Carr","year":"2021","journal-title":"JAMA Dermatol"},{"issue":"2","key":"doi230026r9","doi-asserted-by":"publisher","first-page":"339","DOI":"10.55563\/clinexprheumatol\/keiedv","article-title":"Analysis of patient-physician discrepancy in global assessment of systemic autoimmune myopathy disease activity.","volume":"40","author":"Cordeiro","year":"2022","journal-title":"Clin Exp Rheumatol"},{"issue":"10","key":"doi230026r10","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.3899\/jrheum.150007","article-title":"Discordance of global assessments by patient and physician is higher in female than in male patients regardless of the physician\u2019s sex: data on patients with rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis from the DANBIO registry.","volume":"42","author":"Lindstr\u00f6m Egholm","year":"2015","journal-title":"J Rheumatol"},{"issue":"3","key":"doi230026r11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230317","article-title":"Discordance between the patient\u2019s and physician\u2019s global assessment in rheumatoid arthritis: data from the REAL study-Brazil.","volume":"15","author":"Guimar\u00e3es","year":"2020","journal-title":"PLoS One"},{"issue":"6","key":"doi230026r12","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1111\/apl.2018.21.issue-6","article-title":"Influence of large joint involvement on patient-physician discordance in global assessment of rheumatoid arthritis disease activity analyzed by a novel joint index.","volume":"21","author":"Tago","year":"2018","journal-title":"Int J Rheum Dis"},{"issue":"4","key":"doi230026r13","doi-asserted-by":"publisher","first-page":"2344","DOI":"10.1080\/09546634.2021.1961996","article-title":"A qualitative study of dermatology patients and providers to understand discordant perceptions of symptom burden and disease severity.","volume":"33","author":"Choi","year":"2022","journal-title":"J Dermatolog Treat"},{"issue":"2","key":"doi230026r14","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1177\/120347540100500202","article-title":"Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases.","volume":"5","author":"Chren","year":"2001","journal-title":"J Cutan Med Surg"},{"issue":"10","key":"doi230026r15","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7.","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"doi230026r16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/08870440290001494","article-title":"The revised Illness Perception Questionnaire (IPQ-R).","volume":"17","author":"Moss-Morris","year":"2002","journal-title":"Psychol Health"},{"issue":"3","key":"doi230026r17","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1080\/10705500802222972","article-title":"The brief resilience scale: assessing the ability to bounce back.","volume":"15","author":"Smith","year":"2008","journal-title":"Int J Behav Med"},{"issue":"6","key":"doi230026r18","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/S0092-6566(03)00046-1","article-title":"A very brief measure of the Big-Five personality domains.","volume":"37","author":"Gosling","year":"2003","journal-title":"J Res Pers"},{"issue":"1","key":"doi230026r19","first-page":"81","article-title":"Jefferson Scale of Patient\u2019s Perceptions of Physician Empathy: preliminary psychometric data.","volume":"48","author":"Kane","year":"2007","journal-title":"Croat Med J"},{"key":"doi230026r20","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/1472-6963-5-64","article-title":"Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession.","volume":"5","author":"Dugan","year":"2005","journal-title":"BMC Health Serv Res"},{"issue":"9 Pt 2","key":"doi230026r21","doi-asserted-by":"publisher","first-page":"897","DOI":"10.7326\/0003-4819-134-9_Part_2-200105011-00014","article-title":"Physical symptoms and physician-experienced difficulty in the physician-patient relationship.","volume":"134","author":"Hahn","year":"2001","journal-title":"Ann Intern Med"},{"issue":"1","key":"doi230026r22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/BF02603477","article-title":"The difficult patient: prevalence, psychopathology, and functional impairment.","volume":"11","author":"Hahn","year":"1996","journal-title":"J Gen Intern Med"},{"issue":"5","key":"doi230026r23","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1016\/j.jaad.2020.01.023","article-title":"Product of Investigator Global Assessment and Body Surface Area (IGAxBSA): a practice-friendly alternative to the Eczema Area and Severity Index to assess atopic dermatitis severity in children.","volume":"82","author":"Suh","year":"2020","journal-title":"J Am Acad Dermatol"},{"issue":"3","key":"doi230026r24","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1111\/bjd.v186.3","article-title":"IGAxBSA composite for assessing disease severity and response in patients with atopic dermatitis.","volume":"186","author":"Paller","year":"2022","journal-title":"Br J Dermatol"},{"issue":"1","key":"doi230026r25","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jaad.2020.02.077","article-title":"PGAxBSA composite versus PASI: comparison across disease severities and as therapeutic response measure for Cal\/BD foam in plaque psoriasis.","volume":"83","author":"Gold","year":"2020","journal-title":"J Am Acad Dermatol"},{"issue":"5","key":"doi230026r26","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1586\/14737167.4.5.581","article-title":"The truly remarkable universality of half a standard deviation: confirmation through another look.","volume":"4","author":"Norman","year":"2004","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"issue":"1","key":"doi230026r27","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1186\/s12955-020-01344-w","article-title":"How is the minimal clinically important difference established in health-related quality of life instruments: review of anchors and methods.","volume":"18","author":"Mouelhi","year":"2020","journal-title":"Health Qual Life Outcomes"},{"issue":"2","key":"doi230026r29","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1207\/s15327574ijt0502_4","article-title":"Minimum sample size recommendations for conducting factor analyses.","volume":"5","author":"Mundfrom","year":"2005","journal-title":"Int J Test"},{"issue":"i02","key":"doi230026r30","article-title":"lavaan: an R package for structural equation modeling.","volume":"48","author":"Rosseel","year":"2012","journal-title":"J Stat Softw"},{"issue":"4","key":"doi230026r31","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1111\/hsc.2019.27.issue-4","article-title":"Resilience of patients with chronic diseases: a systematic review.","volume":"27","author":"Kim","year":"2019","journal-title":"Health Soc Care Community"},{"issue":"10","key":"doi230026r32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0111420","article-title":"The efficacy of resiliency training programs: a systematic review and meta-analysis of randomized trials.","volume":"9","author":"Leppin","year":"2014","journal-title":"PLoS One"},{"issue":"3","key":"doi230026r33","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1080\/17437199.2013.813729","article-title":"How can self-efficacy be increased: meta-analysis of dietary interventions.","volume":"8","author":"Prestwich","year":"2014","journal-title":"Health Psychol Rev"},{"key":"doi230026r34","doi-asserted-by":"publisher","first-page":"771","DOI":"10.3389\/fpsyg.2017.00771","article-title":"The mediating roles of upward social comparison and self-esteem and the moderating role of social comparison orientation in the association between social networking site usage and subjective well-being.","volume":"8","author":"Wang","year":"2017","journal-title":"Front Psychol"},{"issue":"3","key":"doi230026r35","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1080\/13607863.2012.743963","article-title":"Downward social comparison and subjective well-being in late life: the moderating role of perceived control.","volume":"17","author":"Stewart","year":"2013","journal-title":"Aging Ment Health"},{"issue":"2","key":"doi230026r36","doi-asserted-by":"publisher","DOI":"10.1177\/2056305120912488","article-title":"The effects of Instagram use, social comparison, and self-esteem on social anxiety: a survey study in Singapore.","volume":"6","author":"Jiang","year":"2020","journal-title":"Soc Media Soc"},{"issue":"6","key":"doi230026r37","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1007\/s10865-010-9279-3","article-title":"Effects of upward and downward social comparison information on the efficacy of an appearance-based sun protection intervention: a randomized, controlled experiment.","volume":"33","author":"Mahler","year":"2010","journal-title":"J Behav Med"},{"issue":"1","key":"doi230026r38","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1177\/1460458213476969","article-title":"Empowering patients through social media: the benefits and challenges.","volume":"20","author":"Househ","year":"2014","journal-title":"Health Informatics J"},{"issue":"2","key":"doi230026r39","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1111\/ijd.v61.2","article-title":"What\u2019s #trending: embracing social media in dermatology.","volume":"61","author":"Long","year":"2022","journal-title":"Int J Dermatol"},{"issue":"6","key":"doi230026r40","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1016\/j.jaad.2020.02.079","article-title":"Efficacy of targeted education in reducing topical steroid phobia: a randomized clinical trial.","volume":"83","author":"Choi","year":"2020","journal-title":"J Am Acad Dermatol"},{"issue":"10","key":"doi230026r41","doi-asserted-by":"publisher","first-page":"2259","DOI":"10.1177\/1359105315573447","article-title":"Coping strategies employed by women with endometriosis in a public health-care setting.","volume":"21","author":"Roomaney","year":"2016","journal-title":"J Health Psychol"},{"issue":"3","key":"doi230026r42","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1046\/j.1365-2133.2002.04622.x","article-title":"A cognitive-behavioural symptom management programme as an adjunct in psoriasis therapy.","volume":"146","author":"Fortune","year":"2002","journal-title":"Br J Dermatol"},{"issue":"10","key":"doi230026r43","doi-asserted-by":"publisher","first-page":"5900","DOI":"10.3390\/ijerph19105900","article-title":"A concept analysis of illness intrusiveness in chronic disease: application of the hybrid model method.","volume":"19","author":"Do","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"doi230026r44","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1080\/07448481.2017.1312415","article-title":"Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses.","volume":"65","author":"Mullins","year":"2017","journal-title":"J Am Coll Health"},{"issue":"10","key":"doi230026r45","doi-asserted-by":"publisher","first-page":"3330","DOI":"10.1007\/s10620-020-06698-1","article-title":"Patient strategies for managing the vicious cycle of fatigue, pain and urgency in inflammatory bowel disease: impact, planning and support.","volume":"66","author":"Dibley","year":"2021","journal-title":"Dig Dis Sci"},{"key":"doi230026r46","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102261","article-title":"Anxiety and depression in multiple sclerosis (MS): antecedents, consequences, and differential impact on well-being and quality of life.","volume":"44","author":"Hanna","year":"2020","journal-title":"Mult Scler Relat Disord"},{"issue":"3","key":"doi230026r47","doi-asserted-by":"publisher","first-page":"211","DOI":"10.2340\/00015555-0452","article-title":"Biopsychosocial mechanisms of chronic itch in patients with skin diseases: a review.","volume":"88","author":"Verhoeven","year":"2008","journal-title":"Acta Derm Venereol"},{"issue":"0","key":"doi230026r48","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jdin.2022.10.010","article-title":"The psychosocial burden of hidradenitis suppurativa in Singapore.","volume":"10","author":"Ooi","year":"2022","journal-title":"JAAD Int"},{"issue":"3","key":"doi230026r49","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/BF02598969","article-title":"Frustrating patients: physician and patient perspectives among distressed high users of medical services.","volume":"6","author":"Lin","year":"1991","journal-title":"J Gen Intern Med"},{"issue":"9","key":"doi230026r50","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0181970","article-title":"Overtreatment in the United States.","volume":"12","author":"Lyu","year":"2017","journal-title":"PLoS One"},{"issue":"4","key":"doi230026r51","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1007\/s41649-020-00145-z","article-title":"The pitfalls of overtreatment: why more care is not necessarily beneficial.","volume":"12","author":"Ooi","year":"2020","journal-title":"Asian Bioeth Rev"},{"issue":"8","key":"doi230026r52","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1001\/archpsyc.62.8.903","article-title":"Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity.","volume":"62","author":"Barsky","year":"2005","journal-title":"Arch Gen Psychiatry"},{"issue":"4","key":"doi230026r53","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1046\/j.1365-2133.2001.04445.x","article-title":"Factors associated with patient satisfaction with care among dermatological outpatients.","volume":"145","author":"Renzi","year":"2001","journal-title":"Br J Dermatol"},{"key":"doi230026r28","volume-title":"Structural Equation Modeling, Pocket Guides to Social Work Research Methods","author":"Bowen","year":"2011"}],"container-title":["JAMA Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/articlepdf\/2807313\/jamadermatology_long_2023_oi_230026_1692117324.96483.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T15:01:48Z","timestamp":1692198108000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2807313"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,1]]},"references-count":53,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamadermatol.2023.2008","relation":{},"ISSN":["2168-6068"],"issn-type":[{"value":"2168-6068","type":"print"}],"subject":[],"published":{"date-parts":[[2023,8,1]]}}}