 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Vanessa B. Sheppard, PhD1, Ann S. O'Malley, MD, MPH1, Marc Schwartz, PhD2, and Jeanne Mandelblatt, MD, MPH2. (1) Oncology, Lombardi Cancer Center, Cancer Control Program, Georgetown University Medical Center, 2233 Wisconsin Ave., NW, Suite 440, Washington, DC 20007, 202-687-7036, vls3@georgetown.edu, (2) Cancer Control Program, Oncology, Lombardi Cancer Center, Georgetown University Medical Center, 2233 Wisconsin Ave., NW, Suite 317, Washington, DC 20007
Background Low income and minority women use recommended preventive services at lower rates than their counterparts. A strong patient - provider relationship has been found to be critical in this population's attainment of necessary services. Patient trust, which is central to quality patient-provider relationships, may be associated with this group's lower service use. The purpose of our study was to explore factors that predict higher trust in primary care providers and the role of patient trust on the use of preventive services in an urban largely low income and minority population.
Methods We conducted a random-digit-dial population-based survey in Washington, DC. Survey respondents were 1,205 women age 40 and over 80% of whom were African American. We examined two measures of trust: overall trust in one's physician, and trust that the provider had no financial conflict of interest that would influence patient care. We assessed preventive services recommended by the US Preventive Services Task Force: mammography, Pap, CBE, blood pressure height and weight measurement, and counseling around diet, and depression. We created an index score summarizing overall self-reported use of preventive services as recommended by one's primary care provider. Patient and primary care characteristics were also examined using previously validated measures.
Results Over two-thirds of respondents reported high trust in their physician. Older respondents (=65) were more trusting of their physicians overall than were younger respondents (p<.01). Primary care characteristics (continuity of care, accessibility of the practice, coordination of specialty care by one's regular provider) were more strongly associated with having high trust, than were socio-demographic, health status and insurance characteristics. Higher trust was significantly associated with greater use of recommended preventive services (OR: 2.3 95% CL: 1.3, 4.0), controlling for the effects of insurance status, primary care and patient characteristics.
Conclusions Overall trust makes a notable contribution to the use of recommend preventive services, over and above the individual contributions of insurance and features of primary care. Stronger patient-physician relationships characterized by high levels of trust may indirectly lead to better health for this low income and minority women.
Learning Objectives:
Keywords: Health Care Delivery, African American
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.