Delayed care and unmet needs among health care system users: When does fiduciary trust in a physician matter?
Delayed care and unmet needs among health care system users: When does fiduciary trust in a physician matter?
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DOI：
10.1111/j.1475-6773.2005.00457.x
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发表时间：
2005-12-01
影响因子：
3.4
通讯作者：
Cook, KS
中科院分区：
文献类型：
--
作者：
Mollborn, S;Stepanikova, I;Cook, KS
目标。检查对医生的信任是否与有正规医生的患者中未得到满足的卫生保健需求和延迟护理有关，并调查对于面临获得卫生保健的结构性障碍的弱势患者，信任与未得到满足的卫生保健需求和延误护理之间的关系是否被削弱。1998-1999年社区跟踪研究(CTS)家庭调查，这是代表美国非制度化人口的横断面样本。这项研究分析了因健康原因通常去看同一医生的成年人(n=29,994)。研究设计。我们估计了信任与未得到满足的医疗保健需求和延迟护理之间的关联的Logistic回归模型。我们测试了信任和获得护理的障碍之间的相互作用，包括少数民族种族/民族、贫困和没有医疗保险。控制变量包括患者的社会人口学特征、健康状况、对可供选择的主治医生的满意度以及过去一年的就诊次数。在大多数患者中，患者对医生的信任与报告延迟护理和未得到满足的卫生保健需求的可能性呈负相关。然而，在非裔美国人、西班牙裔美国人、穷人和没有保险的人中，受托信任与延迟护理的可能性并不显著相关。对于未得到满足的需求，只有未参保者与信任没有显著关联。结果表明，信任与大多数人群获得所需护理的机会增加有关，尽管这种关系因人群而异。
Objective. To examine whether fiduciary trust in a physician is related to unmet health care needs and delayed care among patients who have a regular physician, and to investigate whether the relationships between trust and unmet health care needs and delays in care are attenuated for disadvantaged patients who face structural obstacles to obtaining health care.Data Sources/Study Setting. The 1998-1999 Community Tracking Study (CTS) Household Survey, a cross-sectional sample representative of the U.S. noninstitutionalized population. This study analyzes adults who usually see the same physician for their health care (n=29,994).Study Design. We estimated logistic regression models of the association of trust with unmet health care needs and delayed care. We tested interactions between trust and barriers to obtaining care, including minority race/ethnicity, poverty, and the absence of health insurance. Control variables included patients' sociodemographic characteristics, health status, satisfaction with the available choice of primary physicians, and the number of physician visits during the last year.Principal Findings. Patients' fiduciary trust in a physician is negatively associated with the likelihood of reporting delayed care and unmet health care needs among most patients. Among African Americans, Hispanics, the poor, and the uninsured, however, fiduciary trust is not significantly associated with the likelihood of delayed care. For unmet needs, only the uninsured have no significant association with trust.Conclusions. Results show that trust is associated with improved chances of getting needed care across most subgroups of the population, although this relationship varies by subpopulation.