Examining patients' trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure

Patient Educ Couns. 2014 Nov;97(2):173-9. doi: 10.1016/j.pec.2014.07.022. Epub 2014 Jul 22.


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.

Practice implications: 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.

Keywords: Blacks; Hospital–patient relations; Longitudinal studies; Physician–patient relations; Trust in healthcare system; Trust in physician; Veterans.

Publication types

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

MeSH terms

  • Adult
  • African Americans / psychology*
  • Aged
  • Attitude of Health Personnel
  • Communication*
  • European Continental Ancestry Group / psychology*
  • Female
  • Heart Failure / therapy*
  • Hospitals, Veterans
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Office Visits
  • Patient Satisfaction
  • Physician-Patient Relations*
  • Physicians
  • Prospective Studies
  • Surveys and Questionnaires
  • Trust*
  • United States
  • United States Department of Veterans Affairs