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Translating Primary Care Practice Climate into Patient Activation: The Role of Patient Trust in Physician

Becker, Edmund R. PhD*; Roblin, Douglas W. PhD

doi: 10.1097/MLR.0b013e31817919c0
Original Article

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.

From the *Rollins School of Public Health, Emory University, Atlanta, Georgia; and †Kaiser Permanente, Atlanta, Georgia.

Supported by the Centers for Disease Control and Prevention Grant R01 CD000033 (Becker, PI).

This paper benefited from comments made when it was presented at the Academy Health Annual Meeting, June 5, 2007, Orlando, FL.

Reprints: Edmund R. Becker, PhD, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE. Rm. 630, Atlanta, GA 30345. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.