Patient-Physician Trust among African Americans and the Association with Medication Adherence

Objectives: Medication adherence is essential for appropriate management of chronic diseases such as hypertension. Hypertension is a leading cause of morbidity and mortality among African Americans, typically a result of uncontrolled or undiagnosed hypertension. Uncontrolled hypertension often results from patients stopping their medications when they feel better or not being able to afford their medications. In addition, trust in providers may play a significant role in poor adherence. African Americans treated in safety-net settings are particularly vulnerable. Furthermore those residing in the Deep South bear a disproportionate collective burden from the infamous study at Tuskegee. Therefore, we sought to analyze the association between trust in physicians and medication adherence among African Americans treated in an inner-city safety-net clinic in Birmingham, AL. Methods: Data were obtained from the Alabama Collaboration for Cardiovascular Equality, 2008. Study participants self-reported medication adherence using the Morisky Adherence scale. The Morisky scale ranges from 0 to 4, with higher levels indicating worse adherence. Trust was self-reported by study participants, through the Hall General Trust scale. The Hall Trust scale ranges from 11 to 55 with a higher score indicating greater trust. Associations were quantified using ordinal logistic regression and we adjusted for multiple confounders including education, income, age, uncontrolled hypertension, and beliefs about medications. Results: Our sample consisted of 229 males and 558 females, and had an average age of 53.7 +/- 9.8 years. We collapsed the top two categories of lowest medication adherence due to low cell counts. The results revealed monotonically increasing levels of trust across increasing levels of medication adherence (36.44, 37.09, 39.35, 40.84; overall p >0.001 and p for trend was p>0.001). Results persisted after adjusting for multiple covariates with ordinal logistic regression. Conclusion: Within our sample of hypertensive African Americans we found medication adherence increased as trust increased. Although the root causes of reduced medication adherence remain elusive our findings shed light on the importance of physician trust among African Americans. Patient, physician and system interventions to promote trust may be an effective approach to increasing hypertension medication adherence.