The effects of medical trust on antibiotics adherence in primary care settings: A dyadic mixed-method approach

Antibiotic non-adherence implies a burden for individuals and society (1), may contribute to antibiotic resistance, and has a cost for society. Therefore, a strategy to enhance adherence is more than welcome. Delayed prescription, i.e. only to be used when symptoms worsen or do not improve by a set number of days, has emerged as a potentially effective strategy to reduce the antibiotic misuse. The present research project intends to develop effective recommendations for antibiotic adherence and delayed prescription implementation.When antibiotics first became available, health care was ruled by a paternalistic model, in which one partner of the doctor-patient dyad had to say, and the other to obey. In recent decades, however, this model gave way to patient-centered care (PCC; (2)), to which belong fostering good communication in doctor-patient relationship, reciprocal trust, and shared decision-making (3–8). In doctor-patient communication, the ideal and the practice of making decisions jointly was not often followed by adequate design and operationalization that reflected the dyadic nature of decision making today and reciprocal trust (3,9). Although doctor-patient communication, treatment adherence (10,11) are interpersonal processes (12), their study has often overlooked that (13,14). Therefore, the conceptualization of dyadic processes and the application of an appropriate level of analysis considering both doctor’s and patient’ point of views become crucial. Among the dyadic designs applied to the study of interpersonal phenomena (see (15)), the One-With-Many design (OWM) is the one that allows considering both the doctors’ and the patients’ point of views. The OWM decomposes the variance of a dyadic phenomenon into several effects: “doctor and patient effects”, “relationship effects”, and “reciprocity effects. Only few studies (16,17) applied such a dyadic conceptual approach to the study of doctor-patient relationships, demonstrating that the effects of the decomposition of dyadic communication and mutual trust patterns have differential consequences on patient’s outcomes. Therefore, this project aims to answer the following: (1) How do we reasonably and effectively induce people to effectively respect an antibiotics regime? Is medical dyadic trust helping in understanding the adherence to an antibiotics regime and in drawing effective interventions? (2) What are the mechanisms through which medical dyadic trust is positively associated with antibiotic adherence? (3) Under which circumstances can delayed prescription be an effective strategy to reduce antibiotics non-adherence? What are the barriers and facilitators regarding the application of such a strategy? This will be done by a dyadic mixed-method approach to do justice to today’s medical consultations. The research project includes three studies and a final workshop. Study I studies the sources of variability (i.e., the OWM effects) in doctors’ and patients’ rating their reciprocal trust and quality of communication patterns linked to adherence. Study I also looks into the mechanisms behind the relationship between dyadic medical trust and adherence (i.e., moderation and mediation links). Study II seeks, through a mixed method design, to provide evidence on barriers and facilitators that doctor and patient report regarding delayed prescription. Study III tests a video-message intervention with patients testing delayed prescription, trust, and adherence. Study I, II, and III will inform the final workshops dedicated to the education of doctors. The research project is expected to: (1) Advance knowledge on theoretical aspects of doctor-patient communication and measurement of dyadic processes; (2) Advance knowledge on adherence to antibiotics regimes and begin to readdress, by dissemination and workshops with doctors, the issue of non-adherence; (3) Provide recommendations to public health authorities for the implementation of delayed prescription.