New York University Grossman School of Medicine, Translational Research Building, 227 E 30th St, 6th Floor, New York, NY 10016. Email:
Am J Manag Care. 2023 Aug;29(8):388-392. doi: 10.37765/ajmc.2023.89404.
Research about mistrust in health care often relies on the narrative that lacking trust causes underuse of health care services. This narrative seemed to hold up in the COVID-19 pandemic era, when mistrust in systems and providers led to widely recognized vaccine hesitancy and reluctance to seek care. In this review, we suggest that the "mistrust leads to underuse" narrative is important but incomplete, as mistrust in health care may also cause patients to overuse health care services. We searched the literature for studies, meta-analyses, and interviews that assessed the effect of patient trust on health care utilization. Although overuse literature is sparse, surveys and physician interviews indicate that patients who do not trust their clinicians may seek multiple opinions on the same diagnosis and utilize more costly interventions that are not recommended. Physicians also report being more likely to utilize extraneous tests and medications when patients do not trust them. Hence, problems of trust may lead to both underuse and overuse of health care services. We postulate several factors that may influence whether a mistrustful patient underuses or overuses health care resources, including personal characteristics, environmental characteristics, and levels of analysis, and we encourage more investigation about mistrust and health care overutilization.
关于医疗保健领域不信任的研究往往依赖于这样一种说法，即缺乏信任会导致医疗服务的使用不足。在 COVID-19 大流行时期，这种说法似乎成立，当时人们对系统和提供者的不信任导致了广泛认识到的疫苗犹豫和不愿寻求医疗保健。在这篇综述中，我们认为“不信任导致使用不足”的说法虽然很重要但并不完整，因为对医疗保健的不信任也可能导致患者过度使用医疗保健服务。我们搜索了评估患者信任对医疗保健使用影响的文献，包括研究、荟萃分析和访谈。尽管过度使用的文献很少，但调查和医生访谈表明，不信任医生的患者可能会就同一诊断寻求多个意见，并使用不推荐的更昂贵的干预措施。医生也报告说，当患者不信任他们时，他们更有可能使用多余的检查和药物。因此，信任问题可能导致医疗保健服务的使用不足和过度使用。我们提出了一些可能影响不信任患者是否过度使用或使用医疗保健资源的因素，包括个人特征、环境特征和分析水平，并鼓励对不信任和医疗保健过度使用进行更多的研究。
