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BACKGROUND/RATIONALE:
Background/Significance: Diabetes mellitus is a chronic and progressive disease that causes significant morbidity and mortality and increases health care utilization and costs in both VA and non-VA settings1,2. Diabetes and its complications are more prevalent in minority populations. Black Americans have two-fold increased age adjusted rates of diabetes, are more likely to develop and experience greater disability from diabetes complications compared to White Americans2. Black Americans with diabetes have higher rates of retinopathy, end-stage renal disease, lower limb amputations, and overall death rates2. Therefore, diabetes is a significant public health problem and Black American patients have disproportionately higher morbidity and mortality than their White American counterparts.
Several factors have been postulated to explain the disproportionately higher morbidity and mortality from diabetes in Black Americans and these include their mistrust of the health care system3. It is thought that distrustful patients are less likely to seek routine medical care, take prescribed medications consistently, adhere to treatments recommendations, and maintain continuity with health care providers and health care systems4. Recent studies show that Black Americans are less trusting of physicians and the health care system5. However, little is known about the association between trust and diabetes outcomes and whether distrust of physicians and the health care system contributes to the observed racial/ethnic differences in diabetes outcomes.
OBJECTIVE(S):
Objective: To assess racial/ethnic differences in trust in physicians and distrust of
the health care system among veterans with Type 2 Diabetes and determine the
predictive power of trust in physicians and mistrust of the health care system on personal
health practices and health outcomes in a prospective cohort of veterans with Type 2
Diabetes.
METHODS:
Methodology:
Veterans with Type 2 Diabetes will be identified via the electronic medical records and contacted about participation by the research assistant. Three hundred patients that meet eligibility criteria will be consented and enrolled. At baseline, the general trust in physician scale and the Medical Mistrust Index will be administered to patients by the research assistant. In addition, data on predisposing, enabling, and need factors, along with veteran-specific variables including level of service entitlement, period of service, duration in the VA system, and disability status will be collected. Health utilization and diabetes-specific outcomes will be obtained prospectively from the electronic medical records at 3, 6, and 12 months following enrollment. Primary outcome is the difference in mean scores on the trust and mistrust scales by race/ethnicity. Secondary outcomes are the relationship between trust/mistrust and diabetes outcomes (hemoglobin A1C, LDL cholesterol, blood pressure, and acceptance of influenza vaccination).
FINDINGS/RESULTS:
No findings/results at this time.
IMPACT:
Not yet available.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Communication and Decision Making
Keywords:
Behavior (patient), Behavior (provider), Chronic disease (other & unspecified), Communication -- doctor-patient, Diabetes, Ethnic/cultural, Obesity, Outcomes
MeSH Terms:
Decision Making, Diabetes Mellitus, Ethnic Groups, Health Care Surveys, Knowledge, Attitudes, Practice, Analysis of Variance, Bias (Epidemiology), Women's Health Services
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