Psychosocial Effects on Patient Adherence, Allostatic Load, and Chronic Disease

对患者依从性、稳态负荷和慢性病的心理社会影响

• 批准号: 7905950
• 负责人: DOUGLAS W ROBLIN
• 金额: $ 15.03万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7905950
• 关键词: Acute; Address; Adherence; Adult; Affect; African American; Age; Anxiety; Attenuated; Behavior Therapy; Blood Pressure; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Chronic Kidney Failure; Climate; Cost Sharing; Data; Data Set; Diabetes Mellitus; Dietary intake; Disease; Disease Management; Disease Progression; Distress; Economics; Educational Background; Educational Curriculum; Enrollment; Exercise; Exhibits; Fatty acid glycerol esters; Fiber; Gender; Government Agencies; Health; Health Promotion; Hyperglycemia; Hyperlipidemia; Hypertension; Immunologics; Incidence; Insurance; Knowledge; Life Style; Link; Lipids; Literature; Marital Status; Measures; Mediating; Mediation; Mediator of activation protein; Medical; Metabolic syndrome; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Organ; Outcome; Pathway interactions; Patients; Pharmaceutical Preparations; Physical activity; Physiological; Population; Population Study; Preventive; Psychosocial Stress; Publishing; Race; Regimen; Risk; Role; Services; Social Environment; Social support; Stress; Surveys; Testing; Treatment Protocols; Treatment/Psychosocial Effects; Work; allostatic load; blood pressure regulation; body system; care delivery; cohort; community organizations; compliance behavior; computerized; deprivation; fruits and vegetables; glycemic control; longitudinal analysis; medication compliance; non-compliance; programs; psychosocial; public health relevance; response; social stress; stressor; treatment adherence

DESCRIPTION (provided by applicant): Good glycemic control, lipid control, or blood pressure (BP) control can be achieved by adherence to recommended care, including medication, preventive care, and lifestyle modifications. Good physiologic control, in turn, attenuates risk of progression to acute end-organ disease, such as cardiovascular disease (CVD), or obesity. Many patients, however, are non-adherent with their prescribed treatment protocols and exhibit physiologic dysregulation. Allostatic load is a measure that quantifies cumulative stress-related physiologic dysregulation across multiple body systems. Persistently stressful psychosocial and economic circumstances increase risk of impaired immunologic response, physiologic dysregulation, and end-organ disease. The same factors that influence physiologic dysregulation directly -- financial circumstances (high cost-sharing, economic deprivation), social stress, and personal distress - may also influence physiologic dysregulation indirectly through their effects on non-adherence to recommended care. The primary objective of our proposed study is to test our working hypothesis that adherence to 1) recommended lifestyle and 2) prescribed medication regimen mediates the association of psychosocial stress and personal distress with allostatic load. The principal study population will be 25-59 year old enrollees with Kaiser Permanente Georgia (KPGA) who responded to a 2005 survey on psychosocial circumstances and lifestyle (including leisure physical activity and dietary intake) and who remained enrolled in 2006 for assessment of allostatic load (N=1,915). Consistent with the requirements of PA-06-151, the proposed study will use existing datasets (survey results and computerized administrative data) to create a covariate rich dataset adequately powered to answer an important question unanswered by current models of the association of psychosocial stressors, allostatic load, and disease progression. Is the degree of allostatic load, and its subsequent influence on disease progression, partly mediated by the effects of psychosocial stressors on adherence to a recommended care regimen? PUBLIC HEALTH RELEVANCE: One mechanism by which stressful interpersonal relationships and personal distress and anxiety may contribute to poor health outcomes is through decreasing patient adherence to recommended care. If so, non- adherence to recommended care might be corrected by acknowledging the benefits of social support and stress mitigation in the curriculum of health promotion programs offered through government agencies, community organizations, and both public and private insurance plans.

描述（由申请人提供）：通过遵守推荐的护理，包括药物，预防性护理和生活方式修改，可以实现良好的血糖控制，脂质控制或血压（BP）控制。反过来，良好的生理控制又减轻了进展为急性末期疾病的风险，例如心血管疾病（CVD）或肥胖症。但是，许多患者的规定治疗方案不遵守，并且表现出生理失调。同级负荷是一种量化跨多个身体系统的累积应力相关生理失调的度量。持续压力的社会心理和经济环境增加了免疫反应受损，生理失调和最终器官疾病的风险。直接影响生理失调的相同因素 - 财务状况（高成本分担，经济剥夺），社会压力和个人困扰 - 也可能通过对推荐护理对不遵守的影响而间接影响生理失调。我们拟议的研究的主要目的是检验我们的工作假设，即遵守1）建议的生活方式和2）处方药方案介导了心理压力和个人困扰与同层负荷的关联。首席研究人群将与Kaiser Permanente Georgia（KPGA）为25-59岁的入学者，他们对2005年关于心理社会环境和生活方式的调查（包括休闲体育锻炼和饮食摄入量）做出了回应，并在2006年继续招募，以评估同类载荷（N = 1,915）。与PA-06-151的要求一致，拟议的研究将使用现有数据集（调查结果和计算机管理数据）来创建一个有足够动力的协变量的富数据集，以回答由当前心理社会压力群体，同种局负载，同性恋负载和疾病进展的当前模型的重要问题。同种异体负荷的程度及其对疾病进展的影响，部分是由社会心理压力源对遵守推荐护理方案的依从性的影响？公共卫生相关性：一种机制，通过降低患者遵守推荐的护理，通过压力性的人际关系，个人困扰和焦虑可能导致健康状况不佳的机制。如果是这样，则可以通过承认通过政府机构，社区组织以及公共和私人保险计划提供的健康促进计划课程中的社会支持和缓解压力的福利来纠正建议的护理。