title: Examining patients' trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure.
abstract: OBJECTIVE
  To examine the associations of several characteristics with patients' trust in physician and the healthcare system.
  
  
  METHODS
  A prospective cohort of patients were followed after an exacerbation of heart failure at one of two veterans affairs (VA) hospitals. Patients rated pre-visit and post-visit trust in physician and in the VA healthcare system at follow-up outpatient visits. The associations of trust in physician and VA with covariates were analyzed using multivariate mixed-effects regression.
  
  
  RESULTS
  After adjusting for covariates, post-visit trust in physician was significantly higher than pre-visit trust (P<0.001), but was not significantly different by race. Trust in VA did not change significantly over time (P>0.20), but was significantly lower for Black patients (P<0.001). High self-efficacy to communicate was independently associated with both trust in physician and VA (P<0.001).
  
  
  CONCLUSIONS
  Trust in physician improved over the course of each visit. Trust in VA was not associated with time, but was lower among Black patients. Trust was higher when ratings of communication were higher.
  
  
  CONCLUSIONS
  Trust in physician improved at each visit and was independently associated with communication. Interventions designed to improve communication should be tested for their ability to improve trust in physician and trust in the healthcare system.
authors.affiliation: Jesse Brown Veterans Affairs Medical Center, VA Center of Innovation for Management of Complex Chronic Healthcare, and Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, USA. Electronic address: hsg@uic.edu.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gordon
authors.affiliation: Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA.
authors.forename: Oksana
authors.initials: O
authors.lastname: Pugach
authors.affiliation: Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Berbaum
authors.affiliation: Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, USA.
authors.forename: Marvella E
authors.initials: ME
authors.lastname: Ford
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009819:Office Visits; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D035502:Trust; D014481:United States; D014493:United States Department of Veterans Affairs; D044465:White People / Q000523:psychology*
keywords: Blacks; Hospital–patient relations; Longitudinal studies; Physician–patient relations; Trust in healthcare system; Trust in physician; Veterans