Prevalence of Medical Mistrust and Its Impact on Patient Satisfaction

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Background: There are significant racial and ethnic disparities in overall quality of health, access to care, and healthcare seeking behaviors. Racial differences have also been reported in patient satisfaction, with racial minorities more likely to report lower perceived quality of received care. There are a number of structural and social contributors to disparities in patient satisfaction, one of which is medical mistrust. Medical mistrust (which is significantly more prevalent among racial and ethnic minority groups) is associated with poorer outcomes across the healthcare continuum. 

Objectives: The purpose of this study was to identify the prevalence of patient/caregiver medical mistrust among the pediatric patient population at a large academic medical center in Baltimore, MD and examine its implications on patient satisfaction. The study also sought to examine if there would be racial differences in medical mistrust and patient satisfaction.

Design/Methods: This cross-sectional anonymous survey study was conducted over a two-week period in October 2020.  Study participants were patients (ages 18 to 21) and parents/caregivers of patients <18 years, who presented to primary care clinic or were admitted to the hospitalist service on the pediatrics floor. Participants provided their demographic information, completed the Patient Satisfaction Questionnaire and Group-Based Medical Mistrust Scale (GBMMS). Linear regressions and mediation analyses were preformed to examine race-based medical mistrust and its association with patient satisfaction. 

Results: The sample consisted of 67 participants (67% Black, 24% White) who met study criteria. Black participants reported higher levels of medical mistrust (M=2.29; SD=0.88 vs. M=1.37; SD=0.50. p<.001), which, in turn, was associated with lower patient satisfaction (p<.001). In a parallel mediation analysis, disaggregating the GBMMS into three subscales, there was a significant indirect relationship between race and patient satisfaction via the subscale lack of support from health care providers (95% CI [-1.52, -.02], p<.05). 

Conclusions: Black patients were more likely than White patients to have medial mistrust and greater medical mistrust was significantly associated with lower patient care satisfaction among our sample population. Additionally, Black patients were significantly more likely than White patients to perceive lower support from healthcare providers which, in turn, was associated with lower patient satisfaction. This finding identifies a potential area for intervention to improve Black patients' experience with healthcare. 

University of Maryland Medical Center
University of Maryland School of Medicine
University of Maryland School of Medicine

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