Effect of trust in primary care physicians on patient satisfaction: a cross-sectional study among patients with hypertension in rural China

BACKGROUND: In rural areas of China, hypertension is on the rise and it is drawing the Chinese government's attention. The health outcomes of hypertension management can be positively impacted by patient satisfaction with primary care physicians (PCPs), and the influence of patient trust on satisfaction cannot be ignored. This study aimed to analyze the effect of trust in PCPs on patient satisfaction among patients with hypertension in rural China, and the influence of patients' socio-demographic characteristics and hypertension-management-related factors. METHODS: A multi-stage stratified random sampling method was adopted to investigate 2665 patients with hypertension in rural China. Patient trust and satisfaction were measured using the Chinese version of the Wake Forest Physician Trust Scale and the European Task Force on Patient Evaluation of General Practice. Multiple linear regression was used to analyze the factors influencing patient satisfaction, and structural equation modeling was conducted to clarify the relationships among patient trust and patient satisfaction with PCPs. RESULTS: Patients' trust in their PCPs' benevolence had a positive main effect on all three satisfaction dimensions (clinical behavior: β = 0.940, p < 0.01; continuity and cooperation: β = 0.910, p < 0.01; and organization of care: β = 0.879, p < 0.01). Patients' trust in their PCPs' technical competence had a small negative effect on all three satisfaction dimensions (clinical behavior: β = - 0.077, p < 0.01; continuity and cooperation: β = - 0.136, p < 0.01; and organization of care: β = - 0.064, p < 0.01). Patient satisfaction was also associated with region, gender, insurance status, distance from the nearest medical/health-service institution, and number of visits to PCPs in the past year. CONCLUSIONS: Patients focused more on physicians' benevolence than on their technical competence. Hence, medical humanities and communication skills education should be emphasized for PCPs. Regarding region-based and health-insurance-based differences, the inequities between eastern, central, and western provinces, as well as between urban and rural areas, must also be addressed.