Importance: Patient trust plays a central role in the patient-physician relationship; however, the impact of outpatient visits with a covering physician (covered visits) on the level of trust in usual physician among patients with chronic conditions is unknown. Objective: To determine whether the number of outpatient visits with a covering rheumatologist is associated with patient trust in the usual rheumatologist. Design: Cross-sectional study. Setting: This study used data from the TRUMP2-SLE project conducted at five academic medical centers in Japan. Participants: The participants were Japanese adults with systemic lupus erythematosus who met the 1997 revised classification criteria of the American College of Rheumatology. The enrollment period was February 2020 to October 2021. Exposure: Outpatient visits with a covering rheumatologist in the past year. Main Outcomes and Measures: The main outcome was patient trust in their usual rheumatologist, assessed using the 11-item Japanese version of the modified Trust in Physician Scale (range 0-100). A general linear model with cluster robust variance estimation was used to evaluate the association between the number of outpatient visits with a covering rheumatologist and the patient's trust in their usual rheumatologist. Results: Of the 515 enrolled participants, 421 patients with systemic lupus erythematosus were included in our analyses. The median age was 47.0 years, and 87.2% were women. Thirty-nine usual rheumatologists participated in this study. Patients were divided into groups according to the number of outpatient visits with a covering rheumatologist in the past year as follows: no visits (59.9%; reference group), one to three visits (24.2%; low-frequency group), and four or more visits (15.9%; high-frequency group). The median Trust in Physician Scale score was 81.8 (interquartile range 72.7-93.2). Both the low-frequency and high-frequency groups exhibited lower trust in their usual rheumatologist (mean difference: -3.03 [95% confidence interval -5.93 to -0.80], -4.17 [95% confidence interval -7.77 to -0.58, respectively]). Conclusions and Relevance: This study revealed that the number of outpatient visits with a covering rheumatologist was associated with lower trust in a patient's usual rheumatologist. Further research is needed to address the potential adverse effects of physician coverage on trust in patient's usual rheumatologist.

Dr Kurita reported receiving grants from the Japan Society for the Promotion of Science, consulting fees from GlaxoSmithKline K.K., and payments for speaking at and participating in educational events from Chugai Pharmaceutical Co, Ltd, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation, and the Japan College of Rheumatology. Dr Sada reported receiving a research grant from Pfizer Inc and a payment for speaking at and participating in educational events from GlaxoSmithKline K.K. Dr Wada reported receiving speaker honoraria from Astra Zeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Kyowa Kirin, Novo Nordisk, and Mitsubishi Tanabe, and receives grant support from Bayer, Chugai, Kyowa Kirin, Otsuka, Shionogi, Sumitomo, and Mitsubishi Tanabe. Dr Matsumoto reported receiving grants from Asahi Kasei Pharma, Taisho and AbbVie, receives speaker honoraria from Astra Zeneca, Asahi Kasei Pharma, GlaxoSmithKline and Pfizer and receives a payment for participating in educational events from GlaxoSmithKline.

This study was funded by JSPS KAKENHI Grant Numbers 19KT0021 and 22K19690

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Ethics Committee of Okayama University Hospital gave ethical approval for this work

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The dataset analyzed in this paper is available from the corresponding author on reasonable request.