Examining patients' trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure
Examining patients' trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure
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DOI：
10.1016/j.pec.2014.07.022
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发表时间：
2014-11-01
影响因子：
3.5
通讯作者：
Ford, Marvella E.
中科院分区：
文献类型：
--
作者：
Gordon, Howard S.;Pugach, Oksana;Ford, Marvella E.
目的：探讨几种特征与患者对医生和医疗保健系统信任的关系。方法：对两家退伍军人事务（VA）医院之一的心衰加重患者进行前瞻性队列随访。患者评价访前和访后信任医生和VA医疗保健系统在后续门诊访问。采用多变量混合效应回归分析医师信任与VA与协变量的关系。结果：经协变量调整后，医生的访后信任显著高于访前信任（P < 0.001），但种族间差异不显著。随着时间的推移，对VA的信任度没有显著变化（P < 0.20），但黑人患者的信任度明显降低（P < 0.001）。高沟通自我效能感与医生信任和VA信任独立相关（P < 0.001）。结论：对医生的信任在每次就诊过程中都有所提高。对VA的信任与时间无关，但在黑人患者中较低。沟通的评分越高，信任度越高。实践启示：对医生的信任在每次就诊中都有所提高，并与沟通独立相关。应该测试旨在改善沟通的干预措施是否有能力提高对医生的信任和对医疗保健系统的信任。爱思唯尔爱尔兰有限公司出版。
Objective: To examine the associations of several characteristics with patients' trust in physician and the healthcare system.Methods: A prospective cohort of patients were followed after an exacerbation of heart failure at one of two veterans affairs (VA) hospitals. Patients rated pre-visit and post-visit trust in physician and in the VA healthcare system at follow-up outpatient visits. The associations of trust in physician and VA with covariates were analyzed using multivariate mixed-effects regression.Results: After adjusting for covariates, post-visit trust in physician was significantly higher than pre-visit trust (P < 0.001), but was not significantly different by race. Trust in VA did not change significantly over time (P > 0.20), but was significantly lower for Black patients (P < 0.001). High self-efficacy to communicate was independently associated with both trust in physician and VA (P < 0.001).Conclusions: Trust in physician improved over the course of each visit. Trust in VA was not associated with time, but was lower among Black patients. Trust was higher when ratings of communication were higher.Practice implications: Trust in physician improved at each visit and was independently associated with communication. Interventions designed to improve communication should be tested for their ability to improve trust in physician and trust in the healthcare system. Published by Elsevier Ireland Ltd.