Rationale & Objective Person-centered care (PCC) and trust in physicians influence medication adherence (MA) among patients undergoing dialysis. However, the mechanisms linking PCC to MA, particularly the mediating effect of trust in physicians, remain unclear. This study aimed to investigate the interrelationships between PCC, trust in physicians, and MA.

Study Design Multicenter cross-sectional study.

Setting & Participants Japanese adults receiving outpatient hemodialysis at six dialysis centers.

Exposures PCC was assessed using the 13-item Japanese Primary Care Assessment Tool-Short Form, which included longitudinality and coordination of care. Trust in physicians was measured using the five-item Wake Forest Physician Trust Scale.

Outcome MA was measured using the 12-item Adherence Starts Knowledge (ASK-12) scale.

Analytical Approach General linear models were used to examine the relationships between PCC, trust in physicians, and MA. Mediation analysis determined the extent to which trust in physicians mediated the PCC-MA relationship.

Results In total, 483 patients were analyzed. High-quality PCC was associated with lower barriers to MA in a dose-response manner across JPCAT-SF quartiles compared to no usual source of care (Q1: −3.90 (95% CI: −5.95 to −1.75); Q2: −4.78 (95% confidence interval [CI]: −7.02 to −2.69); Q3: −4.69 (95% CI: −6.96 to −2.58); Q4: −4.95 (95% CI: −7.21 to −2.62). 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 to 33.8%) in Q2 to 33.3% (95% CI: 17.4 to 65.5%) in Q4. Similar findings were observed for PCC subdomains.

Limitation Possible reverse causation.

Conclusions High-quality PCC was associated with MA, with trust in physicians playing a key mediating role. Strategies to enhance MA in patients undergoing hemodialysis should incorporate multidimensional PCC approaches, focusing on building trust and strengthening continuity and coordination of care.

RI has received payment for speaking and educational events from Vantive Japan. T. Toida has received consulting fees from Astellas Pharma Inc. and payment and speaking and educational events from Torii Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., AstraZeneca K.K., Nobelpharma Co., Ltd., and Novo Nordisk Pharma Ltd. T. Toishi received payment for speaking and educational events from Otsuka Pharmaceuticals. MM received payments for speaking and educational events from Astellas Pharma Inc. and Baxter Co., Ltd. TS has received payment for speaking and educational events from Astellas Pharma Inc, AstraZeneca K.K, Vantive Japan, Daiichi Sankyo Co., Ltd., Janssen Pharmaceutical K.K, Kaneka Medix Corp, Kissei Pharmaceutical Co., Ltd., Kowa Co., Ltd., Kyowa Kirin Co., Ltd, Mochida Pharmaceutical Co., Ltd., Nobelpharma Co., Ltd, Novartis Pharma K.K., Novo Nordisk Pharma., Ltd., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical, Terumo Corp, and Torii Pharmaceutical Co., Ltd. NK has received consulting fees from GlaxoSmithKline K.K. and payment for speaking and educational events from Eisai Co., Ltd., Taisho Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., GlaxoSmithKline K.K., Takeda Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., and Baxter Corporation.

This study was supported by JSPS KAKENHI (grant numbers: JP19KT0021, JP22K19690, and JP23K16271). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study adhered to the principles of the Declaration of Helsinki and received ethical approval from the Ethical Review Board of Fukushima Medical University (Approval number: ippan2021-292).

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All data produced in the present work are contained in the manuscript.