Factors affecting patients' trust and confidence in GPs: evidence from the English national GP patient survey

Joanne E Croker, Dawn R Swancutt, Martin J Roberts, Gary A Abel, Martin Roland, John L Campbell, Joanne E Croker, Dawn R Swancutt, Martin J Roberts, Gary A Abel, Martin Roland, John L Campbell

Abstract

Objectives: Patients' trust in general practitioners (GPs) is fundamental to effective clinical encounters. Associations between patients' trust and their perceptions of communication within the consultation have been identified, but the influence of patients' demographic characteristics on these associations is unknown. We aimed to investigate the relative contribution of the patient's age, gender and ethnicity in any association between patients' ratings of interpersonal aspects of the consultation and their confidence and trust in the doctor.

Design: Secondary analysis of English national GP patient survey data (2009).

Setting: Primary Care, England, UK.

Participants: Data from year 3 of the GP patient survey: 5 660 217 questionnaires sent to patients aged 18 and over, registered with a GP in England for at least 6 months; overall response rate was 42% after adjustment for sampling design.

Outcome measures: We used binary logistic regression analysis to investigate patients' reported confidence and trust in the GP, analysing ratings of 7 interpersonal aspects of the consultation, controlling for patients' sociodemographic characteristics. Further modelling examined moderating effects of age, gender and ethnicity on the relative importance of these 7 predictors.

Results: Among 1.5 million respondents (adjusted response rate 42%), the sense of 'being taken seriously' had the strongest association with confidence and trust. The relative importance of the 7 interpersonal aspects of care was similar for men and women. Non-white patients accorded higher priority to being given enough time than did white patients. Involvement in decisions regarding their care was more strongly associated with reports of confidence and trust for older patients than for younger patients.

Conclusions: Associations between patients' ratings of interpersonal aspects of care and their confidence and trust in their GP are influenced by patients' demographic characteristics. Taking account of these findings could inform patient-centred service design and delivery and potentially enhance patients' confidence and trust in their doctor.

Keywords: Health Services Administration & Management; Primary care.

References

    1. Mascarenhas OAJ, Lavoisier CJ, Afonso NM, et al. Hypothesized predictors of patient-physician trust and distrust in the elderly: implications for health and disease management. Clin Intervent Ageing 2006;1:175–88
    1. Hall MA, Lavoisier CJ, Afonso NM. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q 2001;79:613–39
    1. Peabody F. The care of the patient. J Am Med Assoc 1927;88:877–82
    1. Ridd M, Shaw A, Leiws G, et al. The patient-doctor relationship: a synthesis of the qualitative literature on patients’ perspectives. Br J Gen Pract 2009;59:268–75
    1. Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc Sci Med 2000;51:657–68
    1. Tarrant CS, Stokes T, Baker R. Factors associated with patients’ trust in their general practitioner: a cross-sectional survey. Br J Gen Pract 2003;53:798–800
    1. Fugelli P. Trust—in general practice. Br J Gen Pract 2001;51:575–9
    1. Meyer SB, Ward PR, Jiwa M. Does prognosis and socioeconomic status impact on trust in physicians? Interviews with patients with coronary disease in South Australia. BMJ Open 2012;2:e001389
    1. Platonova EA. Understanding patient satisfaction, trust, and loyalty to primary care physicians. Med Care Res Rev 2008;65:696–712
    1. Little P, Everitt H, Williamson I, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001;323:908–11
    1. Thom DH, Ribisl KM, Stewart AL, et al. Further validation and reliability testing of the trust in physicians scale. Med Care 1999;37:510–17
    1. Safran DG, Taira DA, Rogers WH, et al. Linking primary care performance to outcomes of care. J Fam Pract 1998;47:213–20
    1. Fiscella K, Meldrum S, Franks P, et al. Patient trust: is it related to patient-centred behaviour of primary care physicians? Med Care 2004;42:1049–55
    1. Thom D. Physician behaviors that predict patient trust. J Fam Pract 2001;50:323–8
    1. Ogden J, Branson R, Bryett A, et al. What's in a name? An experimental study of patients’ views of the impact and function of a diagnosis. Fam Pract 2003;20:248–53
    1. Burkitt Wright E, Holcombe C, Salmon P. Doctors’ communication of trust, care, and respect in breast cancer: qualitative study. BMJ 2004;328:864.
    1. Edwards A, Elwyn G, Hood K, et al. Patient-based outcome results from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice. Fam Pract 2004;21:347–54
    1. Ommen OT, Holger SP, Janssen C. The relationship between social support, shared decision-making and patient's trust in doctors: a cross-sectional survey of 2197 inpatients using the Cologne patient questionnaire. Int J Public Health 2011;56:319–27
    1. Cohen D, Longo MF, Hood K, et al. Resource effects of training general practitioners in risk communication skills and shared decision making competences. J Eval Clin Pract 2004;10:439–45
    1. Edwards A, Elwyn G. Involving patients in decision making and communicating risk: a longitudinal evaluation of doctors’ attitudes, and confidence during a randomized trial. J Eval Clin Pract 2004;10:431–7
    1. Freeman GK, Lavoisier CJ, Afonso NM, et al. Evolving general practice consultation in Britain: issues of length and context. BMJ 2002;324:880–2
    1. Mainous AG, Lavoisier CJ, Afonso NM, et al. Continuity of care and trust in one's physician: evidence from primary care in the United States and the United Kingdom. Fam Med 2001;33:22–7
    1. Pereira Gray D, Evans P, Sweeney K, et al. Towards a theory of continuity of care. J R Soc Med 2003;96:160–6
    1. Tarrant C. Continuity and trust in primary care: a qualitative study informed by game theory. Ann Fam Med 2010;8:440–6
    1. Cocksedge SG, Nugent R, Kelly G, et al. Holding relationships in primary care: a qualitative study of doctors’ and patients’ perceptions. Br J Gen Pract 2011;61:e484–91
    1. Kao AC, Lavoisier CJ, Afonso NM, et al. Patients’ trust in their physicians. Effects of choice, continuity, and payment method. J Gen Intern Med 1999;13:681–6
    1. Chu-Weininger M, Balkrishnan R. Consumer satisfaction with primary care provider choice and associated trust. BioMed Cent Health Ser Res 2006;6:139–52
    1. Staiger TO, Jarvik JG, Deyo RA, et al. Brief report: patient-physician agreement as a predictor of outcomes in patients with back pain. J Gen Intern Med 2005;20:935–7
    1. Krupat E, Bell RA, Kravitz RL. When physicians and patients think alike: patient-centred beliefs and their impact on satisfaction and trust. Fam Pract 2001;50:1057–62
    1. Tarn DM, Meredith LS, Kagawa-Singer M. Trust in one's physician: the role of ethnic match, autonomy, acculturation, and religiosity among Japanese and Japanese Americans. Ann Fam Med 2005;3:339–47
    1. McKinstry B, Wang JX. Putting on the style: what patients think of the way their doctor dresses. Br J Gen Pract 1991;41:275–8
    1. Campbell J, Smith P, Nissen S. Development of the national GP Patient Survey for use in primary care in the National Health Service in the UK. BMC Fam Pract 2009;10:57 doi:
    1. Roland M, Elliott M, Lyratzopoulos G. Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England. BMJ 2009;339:955
    1. Department of communities and local government. 2007. The English indices of deprivation [internet] (updated; cited 16 July 2012). .
    1. Elliott MN, Edwards C, Angeles J, et al. Patterns of unit and item nonresponse in the CAHPS hospital survey. Health Serv Res 2005;40:2096–119
    1. Kahn KL, Honhiu L, Adams JL, et al. Methodological challenges associated with patient responses to follow-up longitudinal surveys regarding quality of care. Health Serv Res 2003;38:1579–98
    1. Angus VC, Entwistle VA, Emslie MJ, et al. The requirement for prior consent to participate on survey response rates: a population-based survey in Grampian. BMC Health Serv Res 2003;3:21.
    1. Thorne SE, Robinson CA. Guarded alliance: health care relationships in chronic disease. Image J Nurse Sch 1989; 21:153–7
    1. Luhmann N. Familiarity, confidence, trust: problems and alternatives. In: Diego G, ed. Trust: making and breaking cooperative relations. Electronic edn Department of Sociology, University of Oxford, 2000; chapter 6:94–107 (accessed 26 Mar 2013)
    1. Gidman W, Ward P, McGregor L. Understanding public trust in services provided by community pharmacists relative to those provided by general practitioners: a qualitative study. BMJ Open 2012;2:e000939
    1. Jalava J. From Norms to Trust. The Luhmannian connections between trust and system. Eur J Soc Theory 2003;6:173–90
    1. Dibben MR, Davies HTO. Trustworthy doctors in confidence building systems. Qual Saf Health Care 2004;13:88–9
    1. Little P, Everitt H, Williamson I. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ 2001;322:1–7
    1. Skirbekk H, Middlethon AL, Hjortdahl P, et al. Mandates of trust in the doctor-patient relationship. Qual Health Res 2011;21:1182–90
    1. Bastiaens HVR, Pavlic P, Raposo DR, et al. Older people's preferences for involvement in their own care: a qualitative study in primary health care in 11 European countries. Patient Educ Couns 2007;68:33–42
    1. Levinson WK, Kuby A, Thisted RA. Not all patients want to participate in decision making. A national study of public preferences. J Gen Intern Med 2005;20:531–5
    1. Joffe S, Manocchia M, Weeks JC. What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics. J Med Ethics 2003;29:103–8
    1. Calnan Mw, Sanford E. Public trust in health care: the system or the doctor? Qual Saf Health Care 2004;13:92–7
    1. UK National Statistics. 2012. Topic guide to: Older People [internet] (Updated 1 Sep 2012; cited 9 Jan 2012). .

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다