title: Delayed care and unmet needs among health care system users: when does fiduciary trust in a physician matter?
abstract: OBJECTIVE
  To examine whether fiduciary trust in a physician is related to unmet health care needs and delayed care among patients who have a regular physician, and to investigate whether the relationships between trust and unmet health care needs and delays in care are attenuated for disadvantaged patients who face structural obstacles to obtaining health care.
  
  
  METHODS
  The 1998-1999 Community Tracking Study (CTS) Household Survey, a cross-sectional sample representative of the U.S. noninstitutionalized population. This study analyzes adults who usually see the same physician for their health care (n = 29,994).
  
  
  METHODS
  We estimated logistic regression models of the association of trust with unmet health care needs and delayed care. We tested interactions between trust and barriers to obtaining care, including minority race/ethnicity, poverty, and the absence of health insurance. Control variables included patients' sociodemographic characteristics, health status, satisfaction with the available choice of primary physicians, and the number of physician visits during the last year.
  
  
  RESULTS
  Patients' fiduciary trust in a physician is negatively associated with the likelihood of reporting delayed care and unmet health care needs among most patients. Among African Americans, Hispanics, the poor, and the uninsured, however, fiduciary trust is not significantly associated with the likelihood of delayed care. For unmet needs, only the uninsured have no significant association with trust.
  
  
  CONCLUSIONS
  Results show that trust is associated with improved chances of getting needed care across most subgroups of the population, although this relationship varies by subpopulation.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Mollborn
authors.forename: Irena
authors.initials: I
authors.lastname: Stepanikova
authors.forename: Karen S
authors.initials: KS
authors.lastname: Cook
mesh_terms: D003430:Cross-Sectional Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors; D035502:Trust