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Background <p>Person-centered care and trust in physicians influence medication adherence among dialysis patients. However, the mechanisms linking person-centered care to medication adherence, particularly the mediating effect of trust in physicians, remain unclear. This study investigated the interrelationships between person-centered care, trust in physicians, and medication adherence.</p> Methods <p>Using a multicenter cross-sectional study of Japanese adults receiving outpatient hemodialysis at six dialysis centers, person-centered care was assessed using the 13-item Japanese Primary Care Assessment Tool-Short Form (JPCAT-SF), which included longitudinality and care coordination. Trust in physicians was measured using the five-item Wake Forest Physician Trust Scale. Medication adherence was measured using the 12-item Adherence Starts Knowledge (ASK-12) scale. General linear models examined person-centered care, physician trust, and medication adherence relationships. Mediation analysis determined how much trust in physicians mediated the person-centered care-medication adherence relationship.</p> Results <p>A total of 483 patients, with median age and dialysis vintage of 71.9 and 5.7&#xa0;years, respectively, were included in the analysis. High-quality person-centered care was associated with lower barriers to medication adherence in a dose–response manner across JPCAT-SF quartiles compared to no usual source of care. Trust in physicians partially mediated this relationship in a dose–response pattern, with the proportion of the indirect effect increasing from 16.1% (95% CI 4.5–33.8%) in Q2 to 33.3% (95% CI 17.4–65.5%) in Q4. Similar findings were observed for person-centered care subdomains.</p> Conclusions <p>High-quality person-centered care was associated with medication adherence, with trust in physicians playing a key mediating role. Strategies to enhance medication adherence in hemodialysis patients should incorporate multidimensional person-centered care approaches, building trust and strengthening continuity and care coordination.</p> Graphical abstract <p></p>

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Trust in physicians as a mediator of the relationship between person-centered care and medication adherence in patients undergoing hemodialysis: a cross-sectional study

  • 期刊论文

  • 发表日期：

    2025年8月19日

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  • Yusuke Kanakubo,
  • Ryohei Inanaga,
  • Tatsunori Toida,
  • Tetsuro Aita,
  • Mamiko Ukai,
  • Atsuro Kawaji,
  • Takumi Toishi,
  • Masatoshi Matsunami,
  • Yu Munakata,
  • Tomo Suzuki,
  • Tadao Okada,
  • Noriaki Kurita

摘要

Background

Person-centered care and trust in physicians influence medication adherence among dialysis patients. However, the mechanisms linking person-centered care to medication adherence, particularly the mediating effect of trust in physicians, remain unclear. This study investigated the interrelationships between person-centered care, trust in physicians, and medication adherence.

Methods

Using a multicenter cross-sectional study of Japanese adults receiving outpatient hemodialysis at six dialysis centers, person-centered care was assessed using the 13-item Japanese Primary Care Assessment Tool-Short Form (JPCAT-SF), which included longitudinality and care coordination. Trust in physicians was measured using the five-item Wake Forest Physician Trust Scale. Medication adherence was measured using the 12-item Adherence Starts Knowledge (ASK-12) scale. General linear models examined person-centered care, physician trust, and medication adherence relationships. Mediation analysis determined how much trust in physicians mediated the person-centered care-medication adherence relationship.

Results

A total of 483 patients, with median age and dialysis vintage of 71.9 and 5.7 years, respectively, were included in the analysis. High-quality person-centered care was associated with lower barriers to medication adherence in a dose–response manner across JPCAT-SF quartiles compared to no usual source of care. Trust in physicians partially mediated this relationship in a dose–response pattern, with the proportion of the indirect effect increasing from 16.1% (95% CI 4.5–33.8%) in Q2 to 33.3% (95% CI 17.4–65.5%) in Q4. Similar findings were observed for person-centered care subdomains.

Conclusions

High-quality person-centered care was associated with medication adherence, with trust in physicians playing a key mediating role. Strategies to enhance medication adherence in hemodialysis patients should incorporate multidimensional person-centered care approaches, building trust and strengthening continuity and care coordination.

Graphical abstract