糖尿病患者对初级保健提供者的信任与抑郁和焦虑水平之间的关系。
The relationship between trust in primary healthcare providers among patients with diabetes and levels of depression and anxiety.
机构信息
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
出版信息
PLoS One. 2020 Sep 11;15(9):e0239035. doi: 10.1371/journal.pone.0239035. eCollection 2020.
BACKGROUND
Trust in healthcare providers has been shown to improve several clinical and patient-reported outcomes. However, its relationship with depression and anxiety has not been investigated among patients with chronic health conditions, such as diabetes. Therefore, the aim of this study was to examine whether trust in primary care physicians among patients with diabetes is associated with their levels of depression and/or anxiety.
METHOD
Adult patients (≥18 years) with a diagnosis of diabetes, confirmed through their electronic health records, were recruited and interviewed from the primary care clinics of three public hospitals. Patient trust in primary care physicians was assessed using the Health Care Relationship (HCR) Trust scale. Depression and anxiety were assessed using the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7), respectively. Two multiple linear regression analyses were conducted to examine the association of HCR-Trust scores with PHQ-9 and GAD-7 scores controlling for age, sex, Charlson comorbidity index score, education, health literacy, annual income, nationality, duration of illness, and research site.
RESULTS
The number of patients who agreed to be interviewed was 367. Most of the participants were female (61.54%) and Saudi (92.86%). High HCR-Trust scores were negatively associated with PHQ-9 scores (β = -0.18; 95% CI: -0.23 --0.13; P = < .0001), and GAD-7 scores (β = -0.17; 95% CI: -0.22- -0.12; P = < .0001).
CONCLUSIONS
Trust in primary care physicians among patients with diabetes was associated with lower levels of depression and anxiety. Therefore, healthcare providers should adopt a patient-centered care approach that fosters trust in the relationship between their patients and themselves. Further research should explore whether interventions that foster shared decision-making and trust in healthcare providers might also improve the health outcomes of patients with diabetes.
背景
信任医疗保健提供者已被证明可以改善几种临床和患者报告的结果。然而，在患有慢性健康状况（如糖尿病）的患者中，其与抑郁和焦虑的关系尚未得到研究。因此，本研究的目的是检查糖尿病患者对初级保健医生的信任是否与他们的抑郁和/或焦虑水平有关。
方法
从三家公立医院的初级保健诊所招募并采访了年龄在 18 岁及以上、经电子健康记录确认患有糖尿病的成年患者。使用健康护理关系（HCR）信任量表评估患者对初级保健医生的信任。使用患者健康问卷 9 项（PHQ-9）和广泛性焦虑症 7 项（GAD-7）分别评估抑郁和焦虑。进行了两次多元线性回归分析，以在控制年龄、性别、Charlson 合并症指数评分、教育程度、健康素养、年收入、国籍、疾病持续时间和研究地点的情况下，检查 HCR-Trust 评分与 PHQ-9 和 GAD-7 评分的关联。
结果
同意接受采访的患者人数为 367 人。大多数参与者为女性（61.54%）和沙特人（92.86%）。高 HCR-Trust 评分与 PHQ-9 评分呈负相关（β=-0.18；95%CI：-0.23--0.13；P<0.0001），与 GAD-7 评分也呈负相关（β=-0.17；95%CI：-0.22- -0.12；P<0.0001）。
结论
糖尿病患者对初级保健医生的信任与较低的抑郁和焦虑水平有关。因此，医疗保健提供者应采取以患者为中心的护理方法，在患者及其自身之间建立信任关系。进一步的研究应探讨促进医患之间共同决策和信任的干预措施是否也能改善糖尿病患者的健康结果。
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