Trust in physicians as a mediator of the relationship between person-centered care and medication adherence in patients undergoing hemodialysis: A cross-sectional study

Rationale & Objective Person-centered care (PCC) and trust in physicians influence medication adherence (MA) among patients undergoing dialysis. However, the mechanisms linking PCC to MA, particularly the mediating effect of trust in physicians, remain unclear. This study aimed to investigate the interrelationships between PCC, trust in physicians, and MA. Study Design Multicenter cross-sectional study. Setting & Participants Japanese adults receiving outpatient hemodialysis at six dialysis centers. Exposures PCC was assessed using the 13-item Japanese Primary Care Assessment Tool-Short Form, which included longitudinality and coordination of care. Trust in physicians was measured using the five-item Wake Forest Physician Trust Scale. Outcome MA was measured using the 12-item Adherence Starts Knowledge (ASK-12) scale. Analytical Approach General linear models were used to examine the relationships between PCC, trust in physicians, and MA. Mediation analysis determined the extent to which trust in physicians mediated the PCC-MA relationship. Results In total, 483 patients were analyzed. High-quality PCC was associated with lower barriers to MA in a dose-response manner across JPCAT-SF quartiles compared to no usual source of care (Q1: −3.90 (95% CI: −5.95 to −1.75); Q2: −4.78 (95% confidence interval [CI]: −7.02 to −2.69); Q3: −4.69 (95% CI: −6.96 to −2.58); Q4: −4.95 (95% CI: −7.21 to −2.62). Trust in physicians partially mediated this relationship in a dose-response pattern, with the proportion of the indirect effect increasing from 16.1% (95% CI: 4.5 to 33.8%) in Q2 to 33.3% (95% CI: 17.4 to 65.5%) in Q4. Similar findings were observed for PCC subdomains. Limitation Possible reverse causation. Conclusions High-quality PCC was associated with MA, with trust in physicians playing a key mediating role. Strategies to enhance MA in patients undergoing hemodialysis should incorporate multidimensional PCC approaches, focusing on building trust and strengthening continuity and coordination of care.