Health Care Manage Rev. 2022;47(4):289-296. doi: 10.1097/HMR.0000000000000336. Epub 2022 Feb 17.
Patient trust in their clinicians is an important aspect of health care quality, but little evidence exists on what contributes to patient trust.
The aim of this study was to determine workplace, clinician, and patient correlates of patient trust in their clinician.
METHODOLOGY/APPROACH: The sample used baseline data from the Healthy Work Place trial, a randomized trial of 34 Midwest and East Coast primary care practices to explore factors associated with patient trust in their clinicians. A multivariate "best subset" regression modeling approach was used, starting with an item pool of 45 potential variables. Over 7 million models were tested, with a best subset of correlates determined using standard methods for scale optimization. Skewed variables were transformed to the fifth power using a Box-Cox algorithm.
The final model of nine variables explained 38% of variance in patient trust at the patient level and 49% at the clinician level. Trust was related mainly to several aspects of care variables (including satisfaction with explanations, overall satisfaction with provider, and learning about their medical conditions and their clinician's personal manner), with lesser association with patient characteristics and clinician work conditions.
Trust appears to be primarily related to what happens between clinicians and patients in the examination room.
System changes such as patient-centered medical homes may have difficulty succeeding if the primacy of physician-patient interactions in inspiring patient trust and satisfaction is not recognized.
患者对临床医生的信任是医疗质量的一个重要方面，但目前几乎没有证据表明哪些因素有助于建立患者对医生的信任。
本研究旨在确定工作场所、临床医生和患者与患者对其临床医生的信任相关的因素。
方法/方法：该样本使用了健康工作场所试验的基线数据，这是一项针对中西部和东海岸 34 个初级保健实践的随机试验，旨在探索与患者对其临床医生的信任相关的因素。使用多变量“最佳子集”回归建模方法，从 45 个潜在变量的项目池中开始。测试了超过 700 万个模型，使用标准方法确定了相关因素的最佳子集，以优化量表。偏态变量使用 Box-Cox 算法转换为五次方。
最终模型中的九个变量在患者水平上解释了患者信任的 38%的方差，在医生水平上解释了 49%的方差。信任主要与护理变量的几个方面有关（包括对解释的满意度、对提供者的总体满意度以及对自己的病情和医生个人方式的了解），与患者特征和医生工作条件的相关性较小。
信任似乎主要与医生和患者在检查室中的互动有关。
如果不认识到医患互动在激发患者信任和满意度方面的首要地位，以患者为中心的医疗之家等系统变革可能难以成功。
