Effect of trust in primary care physicians on patient satisfaction: a cross-sectional study among patients with hypertension in rural China

What Encourages Patients to Recommend Their Doctor After an Online Medical Consultation? The Influence of Patient-Centered Communication, Trust, and Negative Health Information Seeking Experiences

The doctor-patient relationship in China has become increasingly tense, with patients lacking trust in doctors. Meanwhile, online healthcare flourished, accelerated by the COVID-19 pandemic. This study utilized the direct and indirect pathway model of clinician-patient communication to health outcomes and online trust theory to examine the associations between online patient-centered communication (OPCC), benevolence and ability trust in doctors, negative online health information seeking experiences, and willingness to recommend doctors. The findings revealed that benevolence and ability trust mediated the relationship between OPCC and willingness to recommend doctors. Additionally, when participants had a high level of negative online health information seeking experiences, OPCC had a stronger effect on ability trust; meanwhile, the mediation effect of ability trust between the relationship of OPCC and willingness to recommend was stronger. This study also discussed theoretical and practical implications.

Public trust in general practitioners and its association with primary care contracts: a cross-sectional study of community residents in China

OBJECTIVES

This study aimed to assess the level of public trust in general practitioners (GPs) and its association with primary care contract services (PCCS) in China.

STUDY DESIGN

Cross-sectional study.

METHODS

Between September and December 2021, 4158 residents across eastern, central, and western China completed a structured self-administered questionnaire. Trust was assessed using the Chinese version of Wake Forest Physician Trust Scale. Multivariable linear regression models were established to identify predictors of trust. The effect size of PCCS on trust was estimated by the average treatment effect for the treated (ATT) through propensity score matching.

RESULTS

The study participants had a mean Wake Forest Physician Trust Scale score of 36.82 (standard deviation = 5.45). Enrollment with PCCS (β = 0.14, P < 0.01), Han ethnicity (β = 0.03, P < 0.05), lower educational attainment (β = -0.06, P < 0.01), higher individual monthly income (β = 0.03, P < 0.05), better self-rated health (β = 0.04, P < 0.05), chronic conditions (β = 0.07, P < 0.01), and higher familiarity with primary care services (β = 0.12, P < 0.01) and PCCS (β = 0.21, P < 0.01) were associated with higher trust in GPs. The ATT of PCCS exceeded 1 (P < 0.05).

CONCLUSIONS

PCCS are associated with higher levels of trust in GPs. PCCS may become an effective tool to attract public trust in GPs, although the relationship between the two may be bi-directional.

Process quality, diagnosis quality, and patient satisfaction of primary care in Rural Western China: A study using standardized patients

OBJECTIVES

Patient satisfaction is an essential indicator of the doctor-patient relationship. This study aimed to investigate the relationship between primary care quality and patient satisfaction for non-communicable diseases (NCDs) in rural western China.

METHODS

The study utilized the standardized patients (SPs) approach to present typical symptoms of unstable angina and diabetes to rural healthcare providers. After the consultations, the SPs completed a satisfaction survey. Ordinary least squares and quantile regression were used to examine the association between quality of primary care and patient satisfaction.

RESULTS

We examined 178 anonymous SPs visits. The results showed that higher process quality for angina SPs was correlated with stronger satisfaction for provider ability at a low quantile of ability satisfaction. For diabetes SPs, higher process quality increased overall satisfaction at a low quantile of overall satisfaction, whereas a correct diagnosis significantly contributed to communication satisfaction at a high quantile of communication satisfaction.

CONCLUSIONS

The study found positive associations between process and diagnosis quality and SPs satisfaction. Notably, the influence of process quality was most significant among patients with lower satisfaction levels.

PRACTICE IMPLICATIONS

Provider's process quality could be a key area of improving the satisfaction levels, especially for patients with lower levels of satisfaction.

Age as a Moderator of Health Outcomes and Trust in Physicians

Objectives: Patient trust in physicians is associated with patient satisfaction with healthcare, patients engaging in follow-up care, and positive health-related outcomes. The current study investigated whether age moderated the relation between trust in physicians and four health outcome variables, including patient satisfaction, doctor visits, emergency room visits, and hospital admissions. Methods: 398 English-speaking, community-dwelling adults completed measures of physician trust and important health outcome variables via Amazon Mechanical Turk. Results: Age significantly moderated relations between trust in physicians and hospital admissions, and trust in physicians and patient satisfaction, with both positive relations becoming stronger with increasing age. Discussion: The results highlight the need for a lifespan approach to the study of physician trust and related health outcomes. They offer an avenue for increasing physician trust, engagement with the healthcare system prior to the need for hospitalization, and the reduction of healthcare costs.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

OBJECTIVES

In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.

METHODS

Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction.

RESULTS

The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.

CONCLUSION

This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

How satisfied are patients with nursing care and why? A comprehensive study based on social media and opinion mining

To assess the overall experience of a patient in a hospital, many factors must be analyzed; nonetheless, one of the key aspects is the performance of nurses as they closely interact with patients on many occasions. Nurses carry out many tasks that could be assessed to understand the patient's satisfaction and consequently, the effectiveness of the offered services. To assess their performance, traditionally, expensive, and time-consuming methods such as questionnaires and interviews have been used; nevertheless, the development of social networks has allowed the patients to convey their opinions in a free and public manner. For that reason, in this study, a comprehensive analysis has been performed based on patients' opinions collected from a feedback platform for health and care services, to discover the topics about nurses the patients are more interested in. To do so, a topic modeling technique has been proposed. After this, sentiment analysis has been applied to classify the topics as satisfactory or unsatisfactory. Finally, the results have been compared with what the patients think about doctors. The results highlight what topics are most relevant to assess the patient satisfaction and to what extent. The results remark that the opinion about nurses is, in general, more positive than about doctors.

Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis

BACKGROUND

Medical humanities education is an important part of medical education. The purpose of this study was to determine the effectiveness of medical humanities in improving empathy among medical students and healthcare professionals.

METHODS

PubMed, Embase, EBSCO-ERIC, Web of Science were searched systematically for studies in the English language. The last retrieval date is May 1, 2023. Best Evidence Medical Education (BEME) Global Rating Scale and Kirkpatrick-based results were used to evaluate the quality of literature. In this study, a meta-analysis of continuous data was conducted.

RESULTS

The pooled results by single-arm test meta-analysis showed a benefit with medical humanities programs in empathy (SMD 1.33; 95% CI 0.69-1.96). For single-arm trials of medical humanities program interventions of less than 4 months, 4 months to 12 months, and more than one year, the standardized mean differences(SMD) between post-test and pre-test were 1.74 (P < 0.05), 1.26 (P < 0.05), and 0.13 (P = 0.46), respectively. The results showed a significant difference in the effect of medical humanities programs on male and female empathy (SMD - 1.10; 95% CI -2.08 - -0.13). The SMDs for the study of course, the course combined reflective writing, and the course combined reflective writing and practice as intervention modalities for medical humanities programs were 1.15 (P < 0.05), 1.64 (P < 0.05), and 1.50 (P < 0.05), respectively.

CONCLUSION

Medical humanities programs as a whole can improve the empathy of medical students and health professionals. However, different intervention durations and different intervention methods produce different intervention effects.

The impact of eHealth on relationships and trust in primary care: a review of reviews

BACKGROUND

Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships.

METHODS

A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed.

RESULTS

A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively.

CONCLUSIONS

Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.

Trust in Physicians in the Context of HPV Vaccination of Children from the Perspective of Social Exchange Theory: A Representative Study of Polish Parents

The vaccination of children against human papillomavirus (HPV) effectively prevents HPV infection and HPV-related cancers in women and men. However, HPV vaccination programs are met with vaccine hesitancy, which varies between countries. The coverage in Poland is low, although introducing nationally funded HPV vaccination for girls aged 12-13 in mid-2023 may increase it. The uptake of the HPV vaccine in adolescents is highly affected by parental decisions, which in turn can be influenced by interactions with the physician. The present representative study aimed to analyze the acceptance of the HPV vaccine among Polish parents (n = 360) and the level of trust in HPV vaccination in the pediatrician/general practitioner who takes care of their children aged 9-15 years. The data were gathered in September 2022 using computer-assisted telephone interviews. Most surveyed parents reported trusting their child's physician regarding vaccine recommendations (89.2%) and vaccinated their child with all or most of the vaccines recommended by a national vaccination guideline (94.7%). However, 13.3% declared themselves as moderate or strong vaccine opponents, a group characterized by high (83.4%) distrust in physicians. There was no difference in the awareness of HPV in groups varying in trusting the physicians, but parents who trusted them were more frequently aware of the HPV vaccine. Parental willingness to vaccinate their child against HPV was highly differentiated by the level of trust in the child's physician. The results highlight that trust in physicians is a critical factor shaping decisions for children's vaccination, stressing a continuous need to improve strategies to communicate with patients.

Developing an integrated model of care for vulnerable populations living with non-communicable diseases in Lebanon: an online theory of change workshop

INTRODUCTION

The Syrian crisis, followed by a financial crisis, port explosion, and COVID-19, have put enormous strain on Lebanon's health system. Syrian refugees and the vulnerable host population have a high burden of Non-communicable Diseases (NCD) morbidity and unmet mental health, psychosocial and rehabilitation needs. The International Committee of the Red Cross (ICRC) recently introduced integrated NCD services within its package of primary care in Lebanon, which includes NCD primary health care, rehabilitation, and mental health and psychosocial support services. We aimed to identify relevant outcomes for people living with NCDs from refugee and host communities in northern Lebanon, as well as to define the processes needed to achieve them through an integrated model of care. Given the complexity of the health system in which the interventions are delivered, and the limited practical guidance on integration, we considered systems thinking to be the most appropriate methodological approach.

METHODS

A Theory of Change (ToC) workshop and follow-up meetings were held online by the ICRC, the London School of Hygiene and Tropical Medicine and the American University of Beirut in 2021. ToC is a participatory and iterative planning process involving key stakeholders, and seeks to understand a process of change by mapping out intermediate and long-term outcomes along hypothesised causal pathways. Participants included academics, and ICRC regional, coordination, and headquarters staff.

RESULTS

We identified two distinct pathways to integrated NCD primary care: a multidisciplinary service pathway and a patient and family support pathway. These were interdependent and linked via an essential social worker role and a robust information system. We also defined a list of key assumptions and interventions to achieve integration, and developed a list of monitoring indicators.

DISCUSSION

ToC is a useful tool to deconstruct the complexity of integrating NCD services. We highlight that integrated care rests on multidisciplinary and patient-centred approaches, which depend on a well-trained and resourced team, strong leadership, and adequate information systems. This paper provides the first theory-driven road map of implementation pathways, to help support the integration of NCD care for crises-affected populations in Lebanon and globally.

The Influence of Medicine Approaches on Patient Trust, Satisfaction, and Loyalty

The increase in traditional and complementary medicine (TCM) methods has revealed the necessity of determining relevant behavioral tendencies among healthcare users. In our study, the evaluation of TCM approaches of healthcare users living in North Cyprus in terms of treatment effectiveness, patient trust and patient satisfaction, and the effects of these variables on patient loyalty, were investigated. Data were collected utilizing the scale approach as well as the survey technique in order to measure the variables in the study. A total of 452 participants completed the survey. TCM has a positive effect on treatment effectiveness, patient trust and patient satisfaction. Patient trust and patient satisfaction have a positive effect on patient loyalty, whereas treatment effectiveness did not have a significant effect on patient loyalty. There is a significant and positive mediating effect of patient trust and patient satisfaction between TCM and patient loyalty. However, the mediating effect of treatment effectiveness is not significant between TCM and patient loyalty. This study will help researchers and practitioners understand the importance of attitude, trust, effectiveness, satisfaction and loyalty in relation to TCM. It is suggested that studies that measure the behaviors of patients should increase in order to obtain better health outcomes.

Relationship between self-care compliance, trust, and satisfaction among hypertensive patients in China

Introduction

Hypertension is a growing public health concern worldwide. It is a leading risk factor for all-cause mortality and may lead to complications such as cardiovascular disease, stroke, and kidney failure. Poor compliance of hypertensive patients is one of the major barriers to controlling high blood pressure. Compliance is not ideal among Chinese patients, and increasing patient self-care compliance with hypertension is necessary.

Methods

This article analyzes the status of self-care compliance, trust, and satisfaction among Chinese hypertensive patients using cross-sectional data from Zhejiang Province. We use a multi-group structural equation model (MGSEM) to compare the interrelationships across genders.

Results

The study's findings show that the average trust, satisfaction, and compliance scores are 3.92 ± 0.55, 3.98 ± 0.61, and 3.33 ± 0.41, respectively. Female patients exhibit higher average total scores for trust and compliance than male patients. The SEM results indicate that trust has a direct positive association with compliance [β = 0.242, 95% CI: (0.068, 0.402)] and satisfaction [β = 0.260, 95% CI: (0.145, 0.367)], while their satisfaction is not directly associated with compliance. The results of MGSEM show that trust has an indirect effect on compliance in the male group through satisfaction [β = 0.051, P < 0.05, 95% CI: (0.012, 0.116)]. In the female group, trust has a direct effect on satisfaction [β = 0.235, P < 0.05, 95% CI: (0.041, 0.406)] and compliance [β = 0.319, P < 0.01, 95% CI: (0.086, 0.574)].

Discussion

This study reveals the mechanisms of self-care compliance, trust, and satisfaction among Chinese hypertensive patients. Its findings may serve as a reference for guiding primary healthcare providers to improve hypertension patients' compliance and implement gender-targeted health interventions.

How does people-centered integrated care in medical alliance in China promote the continuity of healthcare for internal migrants: The moderating role of respect

Background

Continuity is crucial to the health care of the internal migrant population and urgently needs improvements in China. Chinese government is committed to promoting healthcare continuity by improving the people-centered integrated care (PCIC) model in medical alliances. However, little is known about the driving mechanisms for continuity.

Methods

We created the questionnaire for this study by processes of a literature research, telephone interviews, two rounds of Delphi consultation. Based on the combination of quota sampling and judgment sampling, we collected 765 valid questionnaires from developed region and developing region in Zhejiang Province. Structural equation models were used to examined whether the attributes of PCIC (namely coordination, comprehensiveness, and accessibility of health care) associated with continuity, and explored the moderated mediating role of respect.

Results

The result of SEM indicated that coordination had direct effect on continuity, and also had mediating effect on continuity via comprehensiveness and accessibility. The hierarchical linear regression analysis showed that the interactive items of coordination and respect had a positive effect on the comprehensiveness (β = 0.132), indicating that respect has positive moderating effect on the relationship between coordination and comprehensiveness. The simple slope test indicated that in the developed region, coordination had a significant effect on comprehensiveness for both high respect group(β = 0.678) and low respect group (β = 0.508). The moderated mediation index was statistically significant in developed areas(β = 0.091), indicating that respect had moderated mediating effect on the relationship between coordination and continuity via comprehensiveness of healthcare in the developed region; however, the moderated mediation effect was not significant in the developing region.

Conclusion

Such regional differences of the continuity promoting mechanism deserve the attention of policy-makers. Governments and health authorities should encourage continuity of healthcare for migrants through improving the elements of PCIC-coordination, comprehensiveness and accessibility of healthcare, shaping medical professionalism of indiscriminate respect, and empowering migrants to have more autonomy over selection of services and decisions about their health.

Exploring Chinese Elderly's Trust in the Healthcare System: Empirical Evidence from a Population-Based Survey in China

This research aims to investigate how much the Chinese elderly trust the healthcare system and the critical factors that influence their trust. We use data from the China Social Survey (CSS) collected by the Chinese Academy of Social Sciences in the year 2019 to examine how demographic factors, social-economic status, internet access, and perceptions of the healthcare system impact the Chinese elderly's trust in the healthcare system. Our research finds male gender, high educational level, and having internet access are negatively related to the elderly's trust in the healthcare system. Our research also reveals that the elderly's trust in the healthcare system was significantly related to their subjective perception of their social-economic status, upward mobility, and perception of accessibility and affordability rather than other objective indicators such as income and financial protection. The results imply that the elderly have a pessimistic expectation of their subjective social status and future possibilities of upward mobility in their later life, which deepens their distrust of the health system. Additionally, the accessibility and affordability of the healthcare system have remained problematic among the Chinese elderly. The study provides important theoretical and practical implications to enhance the elderly's trust in the healthcare system.

Nutrition and physical activity in cancer patients: a survey on their information sources

BACKGROUND

Many cancer patients suffer from problems concerning nutrition and physical activity (PA) during and after their treatment. Forwarding reliable health information could help to alleviate severe symptoms. The present study aimed to examine cancer patients' commonly used information sources on nutrition and PA.

METHODS

An anonymous questionnaire was developed and distributed to German cancer patients in different settings. In total, 90 questionnaires have been completed between October 2021 and March 2022. For analysis, descriptive statistics were used and associations between information sources and patients' lifestyle behaviour explored utilising Spearman's Rho, Mann-Whitney U, and Pearson's Chi Square tests.

RESULTS

The cancer patients received information on nutrition and PA most frequently from physicians (70.9%), family and friends (68%) and browsing the internet (61.3%). Half of the patients (51.1%) had questions concerning these topics during the time of their disease. The majority of those patients (81.8%) reported that their questions were answered. The topics were addressed primarily with outpatient oncologists (60.0%) and in rehabilitation clinics (53.3%). Just about half of the patients (55.3%) felt satisfactorily informed on nutrition and PA in their cancer disease, more so if they talked to their oncologist or family physician (Z = - 2.450, p = 0.014 and Z = - 3.425, p = 0.001 resp.).

CONCLUSION

Cancer patients receive information on nutrition and PA predominantly after their initial treatment. Since they might be missing significant information to alleviate severe symptoms during their treatment, the importance of nutrition and PA should be emphasised by clinicians early on in treatment.

TRIAL REGISTRATION

Trial Registration Number (May 7, 2021): 2021-2149-Bef.

Patient satisfaction and its health provider-related determinants in primary health facilities in rural China

Background

Patient satisfaction is an important outcome measure of health service and is one of the main reasons for the gradual deterioration of doctor–patient relationships in China. This study used the standardized patient (SP) method to explore patient satisfaction and its health provider-related determinants among primary health facilities in rural China.

Methods

The dataset comprised 1138 clinic cases in 728 rural primary health facilities in 31 counties, spread across four provinces. Information regarding the consultation interaction between the unannounced SPs and primary physicians was recorded. Patient satisfaction was gathered from the feedback of SPs after the visit.

Results

The overall average score of SP satisfaction with rural primary health facilities was only 13.65 (SD = 3.22) out of 20. The SP scores were found to be consistent with those of real patients. After controlling variances in patient population via the SP method, the regression analysis demonstrated that health provider-related factors, such as physician-level characteristics, consultation process, affordability, and convenience, have a significant correlation with patient satisfaction among primary physicians. Among factors relating to physician-level characteristics, affordability, convenience and the consultation process of the visit, the quality of the consultation process (e.g., consultation time, proactively providing necessary instructions and other crucial information) were found to be the prominent determinants.

Conclusions

This study revealed the need to improve patient satisfaction in primary health facilities in rural China. To solve this issue, we recommend that policies to increase medical service quality be implemented in rural primary healthcare systems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08349-9.

Policy Goals of Contract Arrangements in Primary Care in Jeopardy: A Cross-Sectional Consumer Satisfaction Survey of Community Residents in Hangzhou, China

Objective

China is attempting to establish a voluntary contracting system in primary care. This study aimed to determine the degree of consumer satisfaction with the entitlements of contract arrangements and its associated factors.

Methods

A stratified cluster sampling strategy was adopted to recruit study participants from three administrative districts of Hangzhou municipality, each containing six residential communities. In each community, 50 households were recruited. A questionnaire was administered through face-to-face interviews with members of the households who signed a contract with community health centers, to collect data regarding their sociodemographic characteristics, health conditions, and knowledge of and attitudes toward the contract entitlements. Consumer satisfaction was measured using six items rated on a five-point Likert scale ranging from “1=very dissatisfied” to “5=very satisfied” and a summed score was calculated. A mixed linear regression model was established to identify individual predictors of consumer satisfaction after adjustment of the random (intercept) effect of household clusters.

Results

Overall, the respondents reported low levels of awareness and understanding of the contract entitlements, with an average knowledge score of 8.21 (SD = 3.74) out of a maximum possible of 19. The respondents had relatively lower levels of satisfaction (satisfied or very satisfied) with their prioritized entitlements (51.5%) and hospitals at home and telemedicine services (31.3%), compared with the contract and insurance policies (85.5%) and medical services provided (87.0%). Female gender, older age, chronic conditions, and perceived better health were associated with higher levels of satisfaction, while poor awareness and knowledge were associated with lower levels of satisfaction.

Conclusion

The study participants perceived limited benefits from the contract arrangements in primary care, which may jeopardize the policy purpose of the arrangements to encourage patients to use primary care as the first contact point in accessing health care services. It is evident that consumer satisfaction with the contract entitlements varies by healthcare needs. Lower levels of satisfaction are associated with poor awareness and knowledge of the entitlements.

An Idealized Clinicogenomic Registry to Engage Underrepresented Populations Using Innovative Technology

Current best practices in tumor registries provide a glimpse into a limited time frame over the natural history of disease, usually a narrow window around diagnosis and biopsy. This creates challenges meeting public health and healthcare reimbursement policies that increasingly require robust documentation of long-term clinical trajectories, quality of life, and health economics outcomes. These challenges are amplified for underrepresented minority (URM) and other disadvantaged populations, who tend to view the institution of clinical research with skepticism. Participation gaps leave such populations underrepresented in clinical research and, importantly, in policy decisions about treatment choices and reimbursement, thus further augmenting health, social, and economic disparities. Cloud computing, mobile computing, digital ledgers, tokenization, and artificial intelligence technologies are powerful tools that promise to enhance longitudinal patient engagement across the natural history of disease. These tools also promise to enhance engagement by giving participants agency over their data and addressing a major impediment to research participation. This will only occur if these tools are available for use with all patients. Distributed ledger technologies (specifically blockchain) converge these tools and offer a significant element of trust that can be used to engage URM populations more substantively in clinical research. This is a crucial step toward linking composite cohorts for training and optimization of the artificial intelligence tools for enhancing public health in the future. The parameters of an idealized clinical genomic registry are presented.

Effects of the Two-Dimensional Structure of Trust on Patient Adherence to Medication and Non-pharmaceutical Treatment: A Cross-Sectional Study of Rural Patients With Essential Hypertension in China

In rural China, treatment adherence of patients with hypertension remains a challenge. Although early research on patient adherence has confirmed the importance of trust in doctors, the relative contribution and influence of the two-dimensional structure of trust on adherence has not been explored. Thus, this study examined the effects of patient trust in primary care physicians' (PCPs) benevolence and ability on medication adherence, dietary management, and physical activity. The data were derived from 2,533 patients at 54 primary health institutions in China (village level) from February 2017 to May 2018. Participants were assessed using the Chinese version of the Wake Forest Physician Trust Scale and the Therapeutic Adherence Subscale for Hypertensive Patients. Other information included region, gender, age, and self-rated health status. The results of multiple linear regression and structural equation modeling confirmed that patient trust in PCPs' benevolence was positively correlated with patient adherence to medication, diet management, and physical activity. Patient trust in PCPs' ability was negatively correlated with adherence to dietary management and physical activity. We concluded that interventions aimed at increasing PCP benevolence have the greatest potential to improve patient adherence to hypertension treatment. Under the country's policy of advocating to improve PCPs' diagnoses and treatment technology, it may be important to cultivate doctors' communication skills, medical ethics, and other benevolent qualities to improve patients' adherence with drug and Non-drug treatments.

Application of interdisciplinary collaborative hospice care for terminal geriatric cancer patients: a prospective randomized controlled study

BACKGROUND

Hospice care (HC) is specialized medical care for terminal patients who are nearing the end of life. Interdisciplinary collaborative hospice care (ICHC) is where experts from different disciplines and patients/caregivers form a treatment team to establish shared patient care goals. However, the ICHC efficacy has not been frequently studied in the terminal geriatric cancer patient (TGCP) population. This study aimed to gain insight into ICHC provided to TGCPs by an ICHC team and identify factors to ameliorate multidimensional HC.

METHODS

166 TGCPs were randomized by a computer-generated random number table using an allocation ratio of 1:1. The patients were divided into the ICHC group and life-sustaining treatment (LST) group. The scores of these questionnaires, such as EORTC, QLQ-C30, Hamilton anxiety scale, the median survival time (MST), symptoms improvement, the median average daily cost of drugs (MADDC), the median total cost of drugs (MTDC) in the last 2 days, and medical care satisfaction were observed in both groups.

RESULTS

After treatment, the improvement of emotional function and symptoms in the ICHC group were statistically higher than those in the LST group (P < 0.05). The MADDC and the MTDC in the last 2 days were statistically lower in the ICHC group than those in the LSTs group (P < 0.01). In addition, the overall satisfaction situation and the cooperation ability in the ICHC group were statistically higher than those in the LST group (P < 0.01).

CONCLUSION

The ICHC could provide TGCPs with coordinated, comfortable, high-quality, and humanistic care.

Patient Trust in Primary Care Physicians: A Mixed Methods Study of Persons with Diabetes at University- Based Clinics in the Eastern Province of Saudi Arabia

BACKGROUND

The establishment of patient trust in physicians is becoming increasingly valuable. Trust can be fundamental to successful patient care, favorable patient outcomes and improved financial savings for healthcare organizations. This study aims to explore patients' perceptions of trust in physicians, determine factors that play a role in this relationship, and to identify ways to improve patient trust.

METHODS

The study was conducted via a mixed-method design using semi-structured in-depth interviews until data saturation was reached (n=24), followed by a cross sectional survey of consecutive sampling until the number of participants (n=256) exceeded the required sample size. Adult patients with diabetes, aged 18-65, attending internal medicine (IM) or family medicine (FM) clinics of King Fahd Hospital of the University, Saudi Arabia were included in the interviews and surveys. Patients' interview transcripts were analyzed into trust dimensions resulting in a 51-item scale. Quality function deployment (QFD) was used to define the highest priority patient requirements. Overall satisfaction was calculated as a satisfaction percent, and factors related to satisfaction were tested using independent samples t-test and ANOVA.

RESULTS

Significant domains for establishing patient trust in physicians were the perceived physician's competency level, comprehensiveness of care, morals, personal traits, and establishing continuity of care. The trust score ranged from 42.0% to 100% with an average of 90.4%. There was no difference between the FM and IM setting, nor between the sociodemographic factors and the patients' satisfaction level. No statistically significant results were found between diabetes type, years of diagnoses, achieving the target HbA1c with patients' satisfaction level and trust. Patients reporting hypo or hyperglycemic symptoms had lower levels of satisfaction than those who did not.

CONCLUSION

Persons with diabetes were more trustful of primary care physicians if they displayed satisfactory communication skills, experience, and a caring attitude.

Where Trust Flourishes: Perceptions of Clinicians Who Trust Their Organizations and Are Trusted by Their Patients

PURPOSE

Trust is an essential component of health care. Clinicians need to trust organizational leaders to provide a safe and effective work environment, and patients need to trust their clinicians to deliver high-quality care while addressing their health care needs. We sought to determine perceived characteristics of clinics by clinicians who trust their organizations and whose patients have trust in them.

METHODS

We used baseline data from the Healthy Work Place trial, a randomized trial of interventions to improve work life in 34 Midwest and East Coast primary care clinics, to identify clinic characteristics associated with high clinician and patient trust.

RESULTS

The study included 165 clinicians with 1,132 patients. High trust by clinicians with patients who trusted them was found for 34% of 162 clinicians with sufficient data for modeling. High clinician-high patient trust occurred when clinicians perceived their organizational cultures to have (1) an emphasis on quality (odds ratio [OR] 4.95; 95% CI, 2.02-12.15; P <.001), (2) an emphasis on communication and information (OR 3.21; 95% CI, 1.33-7.78; P = .01), (3) cohesiveness among clinicians (OR 2.29; 95% CI, 1.25-4.20; P = .008), and (4) values alignment between clinicians and leaders (OR 1.86; 95% CI, 1.23-2.81; P = .003).

CONCLUSION

Addressing organizational culture might improve the trust of clinicians whose patients have high trust in them.

Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach

BACKGROUND

China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China's public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap.

METHODS

We established a hypothetical model that comprised patients' awareness of insurance policies, the fulfillment of patients' expectations of insurance benefits, patients' perceived value of health insurance coverage, patients' satisfaction with health insurance programs, patients' complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases.

RESULTS

The SEM model, with good fit indices, showed that patients' awareness of health insurance policies, insurance program's fulfillment of expectations, and patients' perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients' expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients' perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis.

CONCLUSIONS

Our findings highlight the importance of incorporating patients' perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients' expectations.

Assessment of chronic disease management mode (CDMM) on participants with primary hypertension

Objective

Hypertension requires continuous and long‐term care to prevent associated complications. Chronic disease management mode (CDMM) was developed to improve patients' self‐management. We aimed to evaluate quality of care and clinical outcomes of CDMM versus routine care.

Methods

300 patients aged >30 years with primary hypertension were randomly allocated to the CDMM intervention group (n = 162) or the usual care control group (n = 138). CDMM comprised nursing consultations, telephone contact, online WeChat link, health education, and appropriate referrals during hospitalisation and after discharge. QLICD‐HY (V 2.0) scale was used to evaluate the quality of life. Care outcomes were biochemical parameters, body mass index, blood pressure levels, waist circumference, psychological indicators and quality of life assessed on admission (baseline) and one month post‐care for both groups. Data were collected and analysed using SPSS 20.0.

Results

After one month, the intervention group had 6 mm Hg (95% CI: −5.12 to −9.08) lower SBP and 0.6 mM/L (95% CI: −0.52 to −0.68) lower LDL than the control group. In terms of improvements in BMI, UmAlb or waist circumference, there were no differences between both groups. The intervention group scored better on psychological indicators than controls (P < 0.05), and scores reflecting social and psychological function in the intervention group were significantly higher than scores at baseline, and higher than scores of controls after one month (P < 0.05). In the control group, there was no statistically significant difference between the scores at baseline and after one month.

Conclusions

Under CDMM hypertension care, improvement of blood pressure and LDL was clinically significant. Intervention care further improves social and psychological function among participants with primary hypertension.

Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study

Background

Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated.

Objective

The aim of this study is to examine correlates of patients’ satisfaction with a telemedicine visit.

Methods

In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression.

Results

Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=–0.16), concerns about privacy (r=–0.19), concerns about cost (r=–0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005).

Conclusions

There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed.