"Increasing patients' trust in a physician may be associated with improvement among patients in two important areas: getting care promptly and getting needed health care," the authors write in the December issue of the journal Health Services Research.
"This study emphasizes the importance of examining multiple levels of the context of health care simultaneously," said lead author Stefanie Mollborn of Stanford University. "We found that insurance status and poverty, and race-ethnicity factors influence the interaction level aspect of trust and its associations with unmet needs and delayed care."
The researchers measured the association of trust with unmet health care needs and delayed care in patients from a variety of ethnicities and income levels who had a regular physician.
They found that less trust was associated with delayed care and especially with unmet health care needs in most patients; however, among African-Americans, Hispanics, the poor and the uninsured, delayed care was not affected by trust. Surprisingly, patients who are more educated are more likely to have unmet or delayed health care needs than patients with less education.
Peter Muennig, M.D., of Columbia University, said that some of the findings need to be examined more closely and the patients' characteristics disentangled. "It could be that physicians who rush and fail to address all of a patient's needs are leading to lower levels of trust," Muennig said. "If this is the direction of causality, then delayed care might be seen as an institutional factor and unmet needs as a personal factor between the provider and the patient."
INTERVIEWS
Contact Stefanie Mollborn at 650-723-3956 or smollborn@stanford.edu.
Health Services Research is a bimonthly peer-reviewed journal of health services and policy research. Affiliated with AcademyHealth, an official journal of AcademyHealth, HSR is owned by Health Research and Educational Trust. For information contact Meighan Schreiber, Managing Editor, at 415-502-0201 and hsr.itsa@ucsf.edu or Jennifer Shaw, Business Manager, at 312-422-2646 and jshaw@aha.org.
Mollborn S, et al. Delayed care and unmet needs among health care system users: When does fiduciary trust in a physician matter? Health Services Research 40(6), 2005.
Journal
Health Services Research