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06-09-2012 | Article

Patients with trust in physicians have better glycemic control


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medwireNews: Patients with diabetes who trust their physicians have better glycemic control than those who doubt their docs, investigators report.

Paradoxically, however, diabetic patients of physicians who were good at promoting health interventions were less likely to have good control of their hemoglobin A1C (A1C), say Alicia Fernandez (San Francisco General Hospital, California), and colleagues.

The authors used a novel validated instrument, the Consumer Assessment of Healthcare Providers and Systems Cultural Competence (CAHPS-CC), to measure how well doctors in safety-net clinics imbued trust in low-income patients, how good they were at listening and communicating with their patients, and to what extent they discussed health and wellness interventions such as diet and exercise with patients.

When the researchers applied the instrument to data from a study of an ethnically diverse group of patients with diabetes treated at safety-net clinics in San Francisco and Chicago, Illinois, they found that patients who expressed a high degree of trust in their physicians had a significantly lower risk for poor glycemic control than patients who were less trustful of their doctors (odds ratios [ORs]=0.41 vs 0.53, respectively).

In contrast, patients of doctors who scored well at health promotion (doctor communication-health promotion) were significantly more likely to have poor A1C control compared with patients whose doctors less frequently discussed health promotion (OR=54.3 vs 44.0).

Fernandez and team say that the latter finding is not surprising, given that physicians may be more likely to discuss interventions with patients with higher A1C levels indicating poor glycemic control.

None of the measures they looked at - trust, doctor communication-health promotion, or doctor communication-positive behaviors (eg, listening, showing respect, spending time with the patient) - were associated with changes in either plasma lipids or blood pressure, the investigators found.

"Given the high and disproportionate burden of diabetes on low-income, minority patients, improving glycemic control in this population is crucial to reducing the burden of diabetes-related morbidity, mortality, and healthcare costs in the United States. Our findings highlight the importance of patient physician trust in clinical care," they write in Medical Care.

By Neil Osterweil, medwireNews reporter