Measuring Trust in Primary Care: Assessment, Improvement, and Policy Opportunity

Context: Trust is a fundamental aspect of any human relationship, and medical care is no exception. An ongoing, trusting relationship between clinicians and patients has shown demonstrable value to primary care. Implementing a trust measure in primary care practices can improve our assessment of the physician-patient relationship. It also has implications for reducing health inequities for marginalized groups. However, there is currently no measure of trust in general use, and none endorsed for use by most value-based payment programs.

Objective: To discover existing measures of patient trust in primary care clinicians and assess their potential to be implemented as a a patient-reported outcome measure.

Study Design and Analysis: This purposeful, scoping review searched for any measures created to measure trust in providers specifically in a primary care setting.

Setting or Dataset: Pubmed.

Population studied: Measures of primary care patients’ trust in their physicians.

Intervention/Instrument: A keyword search on PubMed along with scanning references was conducted to find any measures of trust in healthcare. Measures that did not address primary care clinicians were eliminated and the remaining measures were then assessed for their utility to and past usage in primary care.

Outcome Measures: Trust in primary care physicians and each measure’s ability to accurately assess this.

Results: We found four tested measures for assessing patients’ trust in primary care clinicians that are candidates for general use. Of these four, the revised Trust in Physicians Scale and Wake Forest Physician Trust Scale are the most tested and viable options.

Conclusions: Renewed national interest in trust in health care should focus on the capacity to measure it. This review informs the effort to test trust measures for use in research, practice improvement, and value-based payment. Measuring trust, how it relates to outcomes, and learning how it is produced or lost are key to assisting practices and health systems towards earning it.