title: Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease.
abstract: BACKGROUND
  Adherence plays an important role in the therapeutic effectiveness of medical therapy in inflammatory bowel disease (IBD). We assessed whether trust-in-physician and Black race were predictors of adherence.
  
  
  METHODS
  We performed a cross-sectional study of Black (n = 120) and White (n = 115) IBD patients recruited from an outpatient IBD clinic. Self-reported adherence to taking medication and keeping appointments, trust-in-physician, and health-related quality of life were measured using the validated instruments, the modified Hill-Bone Compliance Scale (HBCS), the Trust-in-Physician Scale (TIPS), and the Short IBD Questionnaire (SIBDQ), respectively.
  
  
  RESULTS
  Overall adherence was 65%. Higher adherence correlated with greater trust-in-physician (r = -0.30; P < 0.0001), increasing age (r = -0.19; P = 0.01), and worsening health-related quality of life (r = -0.18; P = 0.01). Adherence was also higher among White IBD patients compared to Blacks (HBSC: 15.6 versus 14.0, P < 0.0001). Trust-in-physician, race, and age remained predictors of adherence to medical management after adjustment for employment, income, health insurance, marital and socioeconomic status, and immunomodulator therapy. The adjusted odds ratio for adherence in Blacks compared to Whites was 0.29 (95% confidence interval: 0.13-0.64). Every half standard deviation increase in trust-in-physician and every incremental decade in age were associated with 36% and 47% higher likelihood of adherence, respectively.
  
  
  CONCLUSIONS
  Trust-in-physician is a potentially modifiable predictor of adherence to IBD medical therapy. Black IBD patients exhibited lower adherence compared to their White counterparts. Understanding the mechanisms of these racial differences may lead to better optimization of therapeutic effectiveness.
authors.affiliation: Mount Sinai Hospital IBD Centre, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada. gnguyen@mtsinai.on.ca
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
authors.forename: Thomas A
authors.initials: TA
authors.lastname: LaVeist
authors.forename: Mary L
authors.initials: ML
authors.lastname: Harris
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Datta
authors.forename: Theodore M
authors.initials: TM
authors.lastname: Bayless
authors.forename: Steven R
authors.initials: SR
authors.lastname: Brant
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D003424:Crohn Disease / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D016896:Treatment Outcome; D035502:Trust; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data