Discontinuity of care and trust in usual physician among patients with systemic lupus erythematosus

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Abstract Importance Patient trust plays a central role in the patient-physician relationship; however, the impact of outpatient visits with a covering physician (covered visits) on the level of trust in usual physician among patients with chronic conditions is unknown. Objective To determine whether the number of outpatient visits with a covering rheumatologist is associated with patient trust in the usual rheumatologist. Design Cross-sectional study. Setting This study used data from the TRUMP 2 -SLE project conducted at five academic medical centers in Japan. Participants The participants were Japanese adults with systemic lupus erythematosus who met the 1997 revised classification criteria of the American College of Rheumatology. The enrollment period was February 2020 to October 2021. Exposure Outpatient visits with a covering rheumatologist in the past year. Main Outcomes and Measures The main outcome was patient trust in their usual rheumatologist, assessed using the 11-item Japanese version of the modified Trust in Physician Scale (range 0–100). A general linear model with cluster robust variance estimation was used to evaluate the association between the number of outpatient visits with a covering rheumatologist and the patient’s trust in their usual rheumatologist. Results Of the 515 enrolled participants, 421 patients with systemic lupus erythematosus were included in our analyses. The median age was 47.0 years, and 87.2% were women. Thirty-nine usual rheumatologists participated in this study. Patients were divided into groups according to the number of outpatient visits with a covering rheumatologist in the past year as follows: no visits (59.9%; reference group), one to three visits (24.2%; low-frequency group), and four or more visits (15.9%; high-frequency group). The median Trust in Physician Scale score was 81.8 (interquartile range 72.7–93.2). Both the low-frequency and high-frequency groups exhibited lower trust in their usual rheumatologist (mean difference: -3.03 [95% confidence interval -5.93 to -0.80], -4.17 [95% confidence interval -7.77 to -0.58, respectively]). Conclusions and Relevance This study revealed that the number of outpatient visits with a covering rheumatologist was associated with lower trust in a patient’s usual rheumatologist. Further research is needed to address the potential adverse effects of physician coverage on trust in patient’s usual rheumatologist. Key Points Question Is the number of outpatient visits with a covering rheumatologist associated with the loss of trust in usual rheumatologist in patients with systemic lupus erythematosus (SLE)? Findings This multicenter cross-sectional study which included 421 patients with SLE revealed that the number of outpatient visits with a covering rheumatologist in the past year was associated with lower levels of trust in the usual rheumatologist. Meaning This study alerts us about the need to prepare for the possible adverse effects of unavoidable outpatient coverage.