Predictors of health care system and physician distrust in hospitalized cardiac patients

Abstract

Trusting relationships among patients, physicians, and the health care system is important in encouraging self-care behaviors in cardiovascular patients. This study aimed to assess the prevalence of health care system and physician distrust in this population, compare the 2 forms of distrust, and describe the demographic, socioeconomic, and psychosocial predictors of high distrust. A total of 1,232 hospitalized adults with acute coronary syndrome or heart failure were enrolled in a prospective, observational study assessing health care system distrust and physician distrust. High health care system distrust (35%) was observed across the population, with lower levels of interpersonal physician distrust (16%). In a multivariate analysis, poor social support and coping skills were strong predictors of both health care system (p=.026, p=.003) and physician distrust (p<.001, p=.006). Individuals with low or marginal health literacy had a higher likelihood of physician distrust (p<.001), but no relation was found between health literacy and health care system distrust. In conclusion, distrust is common among acutely ill cardiac patients. Those with low social support and low coping skills are more distrusting of physicians and the health care system.

Figure 1. Conceptual framework of the Vanderbilt Inpatient Cohort Study [reprinted from (Meyers et al., 2014)]

Figure 2

Scatter plot demonstrating the relation between healthcare system distrust and physician distrust. Darker plots represent density of number of individuals.

Figure 3. Multivariate analysis of continuous variables and Healthcare System Distrust

(A): Forest plot displaying each linear covariate in multivariable analysis (x axis). Odds ratios are shown on the y-axis with a range of 0.25 – 4, and a dark horizontal line at 1. The reference groups for the categorical variables are male, white, married/partner, employed, income <$25K, and diagnosis of ACS*. (B): Graphical display of continuous variables modeled with non-linear effects and odds of healthcare system distrust. The plot shows predictive characteristics along the x-axis (Age, ESSI, s-TOFHLA, Subjective Numeracy Scale, PHQ, Brief Resilient Coping Scale). The y-axis shows increasing odds ratios of physician distrust ranging from 0.25 to 4. A horizontal line is placed at 1. Mean odds ratios are displayed with corresponding 95% confidence interval. *The interquartile unit changes are education: 3 years, MIDUS: 7 points, HRS: 8 points, and BHLS: 4 points. Range was limited to the 1^st and 99^th percentile.

Figure 4. Multivariate analysis of continuous variables and Physician Distrust

(A): Forest plot displaying each linear covariate in multivariable analysis (x axis). Odds ratios are shown on the y-axis with a range of 0.25 -4, and a dark horizontal line at 1. The reference groups for the categorical variables are male, white, married/partner, employed, income <$25K, and diagnosis of ACS*. (B): Graphical display of continuous variables modeled with non-linear effects and odds of physician distrust. The plot shows predictive characteristics along the x-axis (Age, ESSI, s-TOFHLA, Subjective Numeracy Scale, PHQ, Brief Resilient Coping Scale). The y-axis shows increasing odds ratios of physician distrust ranging from 0.25 to 4. A horizontal line is placed at 1. Mean odds ratios are displayed with corresponding 95% confidence interval. *The interquartile unit changes are education: 3 years, MIDUS: 7 points, HRS: 8 points, and BHLS: 4 points. Range was limited to the 1^st and 99^th percentile.