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Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease†

  1. Geoffrey C. Nguyen MD, PhD1,2,*,
  2. Thomas A. LaVeist PhD3,
  3. Mary L. Harris MD2,
  4. Lisa W. Datta MSc2,
  5. Theodore M. Bayless MD2,
  6. Steven R. Brant MD2,4

Article first published online: 28 JAN 2009

DOI: 10.1002/ibd.20883

Issue

Inflammatory Bowel Diseases

Inflammatory Bowel Diseases

Volume 15, Issue 8, pages 1233–1239, August 2009

Additional Information

How to Cite

Nguyen, G. C., LaVeist, T. A., Harris, M. L., Datta, L. W., Bayless, T. M. and Brant, S. R. (2009), Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. Inflamm Bowel Dis, 15: 1233–1239. doi: 10.1002/ibd.20883

Author Information

  1. 1

    Mount Sinai Hospital IBD Centre, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada

  2. 2

    Harvey M. and Lyn P. Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

  3. 3

    Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

  4. 4

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

*600 University Ave., Ste. 437, Toronto, Ontario M5G 1X5, Canada

  1. †

    The sponsors played no role in the design, data collection, data analysis, or interpretation of results of this study.

Publication History

  1. Issue published online: 15 JUL 2009
  2. Article first published online: 28 JAN 2009
  3. Manuscript Accepted: 22 DEC 2008
  4. Manuscript Received: 10 DEC 2008

Funded by

  • Senior Research Award by the Crohn's and Colitis Foundation of America
  • National Institutes of Health. Grant Number: DK62431
  • National Center for Minority Health and Health Disparities (NCMHD)
  • AGA Research Scholar Award
  • Sherlock Hibbs Estate Funds

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Keywords:

  • adherence;
  • African American;
  • Black;
  • Crohn's disease;
  • inflammatory bowel disease;
  • race;
  • trust in physician;
  • ulcerative colitis

Abstract

Background: Adherence plays an important role in the therapeutic effectiveness of medical therapy in inflammatory bowel disease (IBD). We assessed whether trust-in-physician and Black race were predictors of adherence.

Methods: We performed a cross-sectional study of Black (n = 120) and White (n = 115) IBD patients recruited from an outpatient IBD clinic. Self-reported adherence to taking medication and keeping appointments, trust-in-physician, and health-related quality of life were measured using the validated instruments, the modified Hill-Bone Compliance Scale (HBCS), the Trust-in-Physician Scale (TIPS), and the Short IBD Questionnaire (SIBDQ), respectively.

Results: Overall adherence was 65%. Higher adherence correlated with greater trust-in-physician (r = −0.30; P < 0.0001), increasing age (r = −0.19; P = 0.01), and worsening health-related quality of life (r = −0.18; P = 0.01). Adherence was also higher among White IBD patients compared to Blacks (HBSC: 15.6 versus 14.0, P < 0.0001). Trust-in-physician, race, and age remained predictors of adherence to medical management after adjustment for employment, income, health insurance, marital and socioeconomic status, and immunomodulator therapy. The adjusted odds ratio for adherence in Blacks compared to Whites was 0.29 (95% confidence interval: 0.13–0.64). Every half standard deviation increase in trust-in-physician and every incremental decade in age were associated with 36% and 47% higher likelihood of adherence, respectively.

Conclusions: Trust-in-physician is a potentially modifiable predictor of adherence to IBD medical therapy. Black IBD patients exhibited lower adherence compared to their White counterparts. Understanding the mechanisms of these racial differences may lead to better optimization of therapeutic effectiveness.

(Inflamm Bowel Dis 2009)

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