Translating primary care practice climate into patient activation: the role of patient trust in physician

Med Care. 2008 Aug;46(8):795-805. doi: 10.1097/MLR.0b013e31817919c0.


Background: Little is known about processes by which proactive primary care teams might activate their patients. We examine the role of trust in patient-physician relationships for translating practice teamwork into patient activation.

Methods: Data were collected by surveys of adult enrollees and primary care teams of a group-model managed care organization in metropolitan Atlanta. Enrollees who were 25-59 years of age were randomly sampled from 3 condition cohorts (diabetes, elevated lipids but no coronary artery disease history, and low risk). A total of 2224 responded to a mixed mode survey in 2005 (42% response rate). Ninety-seven practitioners and 187 support staff of 16 primary care teams responded to a practice climate survey in 2004 (85% response rate). Practice climate is a multidimensional concept measuring support and collaboration with a team. Linear models of patients nested within their primary care teams were estimated for patient trust in physician as a function of practice climate and for activation as a function of trust, adjusted for other respondent characteristics.

Results: We found significant, positive associations between practice climate and patient trust in their primary care physicians and between patient trust and activation in their health.

Conclusions: Our study shows 1 process by which practice climate translates into patient activation. Supportive interactions among practitioners and staff within primary care teams facilitate trust-building interactions between practitioners and patients. Supportive, trustworthy interactions, in turn, help to ameliorate the inherent imbalance in power between patients and physicians, contributing to patients who take a more active role in their health.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Diabetes Mellitus / blood
  • Female
  • Georgia
  • Health Behavior*
  • Humans
  • Life Style
  • Linear Models*
  • Lipids / blood
  • Male
  • Managed Care Programs*
  • Middle Aged
  • Patient Care Team / organization & administration*
  • Physician-Patient Relations*
  • Primary Health Care*


  • Lipids