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The Influence of Primary Care Practice Climate on Patient Trust in Physician, Activation and Health 

Authors: Becker ER, Rollins School of Public Health at Emory University. Roblin DW, Center for Health Research / Southeast, Kaiser Permanente Georgia.

Objective:  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.

Design: 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. Ninety-seven practitioners and 187 support staff of 16 primary care teams responded to a practice climate survey in 2004. 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 characteristic

Key Findings:

• Across each condition cohort, higher activation correlates with higher levels of physician trust
• In a multivariate model, trust in physician had the strongest association with patient activation (0.19 point increase per 1 point increase in trust; p<0.01)