Abstract 9007: Higher Level of Chronic Illness Management is Associated With Greater Trust in the Heart Transplant Team

Abstract

Trust is associated with better patient outcomes, such as better medication adherence and improved patient satisfaction. However, the association between trust and level of chronic illness management (CIM) has not yet been addressed. We assessed the hypothesis that level of CIM will be associated with trust in the HTx team. Additionally, we explored potential meso-level moderators of this relationship (time spent on patient visits, number of visits, multidisciplinarity, CIM competencies, and CIM preparedness of the healthcare team). A secondary analysis was conducted using the international cross-sectional BRIGHT study, which included 1397 HTx recipients and 100 HTx clinicians from 36 HTx centers across 11 countries. Level of CIM was measured using the Patient Assessment of Chronic Illness Care (PACIC – patients’ report) and the CIMI BRIGHT (clinicians’ reports). Patients’ trust in the HTx team was measured using an adapted Wake Forest Trust scale. Multiple logistic regression was used to test the hypothesis. 1397 patients (mean age 53.6 13.2 years; 72.7% male; 85.9% white; average time post HTx 3.4 1.4 years) and 100 HTx clinicians (mean age 46.2 10.2 years; 87% female; 85% nurses; mean time worked in HTx center 10.0 7.5 years) were included. Even after controlling for patient’s age, gender, race, education, employment, years post HTx, health literacy, language congruency, and comorbidities, level of CIM as assessed by both patients and clinicians was significantly associated with trust in the HTx team (odds ratio (OR)=1.85, p<.001; OR=1.35, p=.012, respectively). Patients from centers with higher levels of CIM were more likely to trust their HTx team. Lastly, only ‘ time spent on patient visits ’ significantly moderated the relationship between level of CIM (PACIC and CIMI) and trust (OR=1.61, p=.037; OR=1.56, p=.048, respectively), wherein the impact of time in fostering trust towards the HTx team was greater when level of CIM was high. In conclusion, level of CIM (assessed from patients’ and clinicians’ perspectives) was positively associated with trust. Our findings also suggest that allotting more time for patients during follow-up visits is a relevant factor to consider to further optimize the HTx care ecosystem.