Public Knowledge of Industry Payments Leads to Distrust Among Patients

A recent study has found that Americans have become less trusting of the medical profession and in their own physicians.

Investigators found an association between a decline in trust and the disclosure of industry payments, which became mandatory after the passage of the Physician Payments Sunshine Act (PPSA) in the 2010 Patient Protection and Affordable Care Act and investigators.

Investigators sought to determine whether the nationwide public disclosure of industry payments has impacted Americans’ trust of physicians. The first survey consisted of 3542 American adults 18 years and older selected from KnowledgePanel, a representative household survey tainted by the research firm GfK. Of the 3542, 2711 respondents were contacted for a follow-up survey 2 years later and 2180 completed that survey. For the purpose of the analyses, investigators chose to focus on the subsample of individuals who did not change their physician between the 2 surveys (n=1388).

The study had 4 different outcomes. The Wake Forest summary score for trust in one’s own physician, the Wake Forest summary score for trust in the medical profession, the rating of expertise of one’s own physician, and the rating of satisfaction with the care provided by one’s own physician. Investigators used the 5-item Wake Forest measure of trust in one’s own physician and the 5-item validated Wake Forest measure of trust in the medical profession to assess the level of trust in survey respondents. Both scales have summary score values ranging from 5 to 25.

The first survey was conducted in Sept. 2014, shortly before the initial public disclosure of industry payments, and again in Sept. 2016. Investigators estimated difference-in-difference associations in 3 samples — a national sample, a sample of northeastern states, and a sample of states in the Midwest.

Investigators found that respondents reported greater mean levels of trust in their own physician than in the medical profession in general. Open Payments was associated with a statistically significant .35-point decline in mean levels of trust in the medical profession.

Only 3% of respondents reported knowing whether their physician had received any industry payments. In the national sample, the knowledge that one’s own physician had not received any industry payments was associated with 1.56 points greater mean levels of trust in one’s own physician compared to not knowing whether one’s own physician had received payments.

Investigators determined that patients’ trust in their own physicians and in the medical profession decreased after the release of Open Payments data, a decline of .56 points from the initial mean Wake Forest measure of trust in one’s own physician. Respondents appeared to be less trusting in their own physician regardless of whether they had industry ties.

Investigators noted little association between Open Payments and the respondents’ ratings of their physician’s expertise or in the satisfaction with their care. Investigators concluded that while transparency appears to be a sound policy, the residual effects may prevent transparency from properly informing patients.

Investigators pointed out that there were several limitations within their study. They noted they were unable to determine if other changes in the health care environment differentially affected sunshine and non-sunshine states between 2014 and 2016. Additionally, restricting the sample to individuals who responded to both the 2014 and 2016 survey meant their sample did not fully represent US households.

In an invited commentary, Kathryn Tringale, MD, MAS, and Jona Hattangadi-Gluth, MD, wrote about how disclosure and transparency has brought unintended consequences but have started an important discussion in medicine.

“Trust is complex, dynamic, and highly variable. Recent events, both big and small, can greatly influence trust in a physician. Still, the findings in the study by Kanter et al suggest that there could be powerful but subtle influences of physician-industry financial ties on patients’ perceptions of the medical field,” Trinagle and Hattangadi-Gluth wrote. “It forces us to question the notion that public disclosure equates to transparency and that this transparency is enough to guarantee patient trust.”

This study, titled “US Nationwide Disclosure of Industry Payments and Public Trust in Physicians,” was published in JAMA Network Open.