Kanakubo Yusuke, Inanaga Ryohei, Toida Tatsunori, Aita Tetsuro, Ukai Mamiko, Kawaji Atsuro, Toishi Takumi, Matsunami Masatoshi, Munakata Yu, Suzuki Tomo, Okada Tadao, Kurita Noriaki
Tessyoukai Kameda Family Clinic Tateyama, Tateyama, Chiba, Japan.
Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
J Nephrol. 2025 Aug 19. doi: 10.1007/s40620-025-02387-2.
Person-centered care and trust in physicians influence medication adherence among dialysis patients. However, the mechanisms linking person-centered care to medication adherence, particularly the mediating effect of trust in physicians, remain unclear. This study investigated the interrelationships between person-centered care, trust in physicians, and medication adherence.
Using a multicenter cross-sectional study of Japanese adults receiving outpatient hemodialysis at six dialysis centers, person-centered care was assessed using the 13-item Japanese Primary Care Assessment Tool-Short Form (JPCAT-SF), which included longitudinality and care coordination. Trust in physicians was measured using the five-item Wake Forest Physician Trust Scale. Medication adherence was measured using the 12-item Adherence Starts Knowledge (ASK-12) scale. General linear models examined person-centered care, physician trust, and medication adherence relationships. Mediation analysis determined how much trust in physicians mediated the person-centered care-medication adherence relationship.
A total of 483 patients, with median age and dialysis vintage of 71.9 and 5.7 years, respectively, were included in the analysis. High-quality person-centered care was associated with lower barriers to medication adherence in a dose-response manner across JPCAT-SF quartiles compared to no usual source of care. Trust in physicians partially mediated this relationship in a dose-response pattern, with the proportion of the indirect effect increasing from 16.1% (95% CI 4.5-33.8%) in Q2 to 33.3% (95% CI 17.4-65.5%) in Q4. Similar findings were observed for person-centered care subdomains.
High-quality person-centered care was associated with medication adherence, with trust in physicians playing a key mediating role. Strategies to enhance medication adherence in hemodialysis patients should incorporate multidimensional person-centered care approaches, building trust and strengthening continuity and care coordination.
以患者为中心的护理以及对医生的信任会影响透析患者的用药依从性。然而，将以患者为中心的护理与用药依从性联系起来的机制，尤其是对医生信任的中介作用，仍不清楚。本研究调查了以患者为中心的护理、对医生的信任和用药依从性之间的相互关系。
采用多中心横断面研究，对在六个透析中心接受门诊血液透析的日本成年人进行调查，使用包含纵向性和护理协调的13项日本初级保健评估工具简表（JPCAT-SF）评估以患者为中心的护理。使用5项维克森林医生信任量表测量对医生的信任度。使用12项依从性起始知识（ASK-12）量表测量用药依从性。通用线性模型检验了以患者为中心的护理、医生信任和用药依从性之间的关系。中介分析确定了对医生的信任在多大程度上中介了以患者为中心的护理与用药依从性之间的关系。
共有483名患者纳入分析，年龄中位数和透析时间分别为71.9岁和5.7年。与没有常规护理来源相比，高质量的以患者为中心的护理在JPCAT-SF四分位数中以剂量反应方式与较低的用药依从性障碍相关。对医生的信任以剂量反应模式部分中介了这种关系，间接效应的比例从第二四分位数的16.1%（95%CI 4.5-33.8%）增加到第四四分位数的33.3%（95%CI 17.4-65.5%）。在以患者为中心的护理子领域也观察到了类似的结果。
高质量的以患者为中心的护理与用药依从性相关，对医生的信任起着关键的中介作用。提高血液透析患者用药依从性的策略应纳入多维度的以患者为中心的护理方法，建立信任并加强连续性和护理协调。
