title: 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.
authors.affiliation: a Division of Cardiovascular Medicine, Department of Medicine , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.
authors.forename: Charu
authors.initials: C
authors.lastname: Gupta
authors.forename: Susan P
authors.initials: SP
authors.lastname: Bell
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schildcrout
authors.forename: Sarah
authors.initials: S
authors.lastname: Fletcher
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Goggins
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012944:Social Support; D035502:Trust