Self-Care & Outcomes Among Kidney Transplant Recipients

自理

• 批准号: 7303293
• 负责人: Elisa J Gordon
• 金额: $ 12万
• 依托单位: ALBANY MEDICAL COLLEGE
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7303293
• 关键词: attitude; behavioral /social science research tag; belief; clinical research; culture; health behavior; health care policy; human subject; immunosuppression; interview; kidney transplantation; longitudinal human study; outcomes research; self care; socioeconomics; therapy compliance; transplant rejection

DESCRIPTION (provided by applicant): Kidney loss in the first 10 years following transplantation remains a significant problem despite tremendous scientific advances in treating acute rejection and immunosuppression. This problem is pressing because racial/ethnic and socioeconomic disparities persist in kidney survival rates causing inequities in graft outcomes. One possible explanation for this survival difference is social inequities in self-care practices of compliance and symptom management. Self-care is essential to the survival of the kidney. But the resources (e.g., financial, social support) for self-care are not equitably distributed in the population. Under the new 2001 Medicare bill (HR 4577), only kidney recipients with disabilities obtain full support for as long as the new kidney functions, but most kidney recipients do not have disabilities, so financial support remains limited. This limitation can lead to the waste of scarce kidneys because it prevents patients from sustaining their kidneys after three years. Consequently, the capacity for and practice of self-care varies by race/ethnicity and insurance status. The proposed interdisciplinary study will examine the social, cultural, and economic strategies and resources that kidney recipients mobilize to keep their kidneys healthy in the context of limited financial support from insurers. The specific aims of this study are to: 1) examine transplant recipients' health beliefs about kidney survival, compliance, and rejection; 2) investigate transplant recipients' practices of self-care and financially maintaining a kidney transplant; 3) measure the impact of recipients' health beliefs and self-care practices on graft outcomes; and 4) compare self-care practices and graft outcomes among kidney recipients with different demographic and socioeconomic backgrounds. To accomplish these goals, the proposed four-year longitudinal study will use a multi-method approach for data collection. Data will be gathered prospectively through interviews with kidney recipients every six months and through medical chart review. Identifying the sociocultural and economic processes associated with better graft survival is important for: a) preventing kidney rejection, b) devising compliance interventions, c) preparing candidates for transplant through education, d) evaluating health policies designed to prevent financial barriers to kidney transplantation, and e) eliminating disparities in long-term kidney survival rates

描述（由申请人提供）： 尽管在治疗急性排斥反应和免疫抑制方面取得了巨大的科学进步，但移植后头 10 年的肾丧失仍然是一个重大问题。这个问题很紧迫，因为种族/民族和社会经济差异在肾脏存活率方面持续存在，导致移植结果的不平等。这种生存差异的一个可能解释是依从性和症状管理的自我护理实践中的社会不平等。自我护理对于肾脏的生存至关重要。但用于自我保健的资源（例如财政、社会支持）在人口中的分配并不公平。根据新的 2001 年医疗保险法案 (HR 4577)，只有残疾肾接受者在新的肾功能恢复期间才能获得全额支持，但大多数肾接受者没有残疾，因此财务支持仍然有限。这种限制可能会导致稀缺肾脏的浪费，因为它会阻止患者在三年后维持其肾脏。因此，自我护理的能力和实践因种族/民族和保险状况而异。 拟议的跨学科研究将研究肾脏接受者在保险公司有限的财政支持的情况下为保持肾脏健康而动员的社会、文化和经济策略和资源。本研究的具体目的是：1）检查移植受者对肾脏存活、依从性和排斥反应的健康信念； 2) 调查移植受者的自我保健和经济维持肾移植的情况； 3）衡量接受者的健康信念和自我保健实践对移植结果的影响； 4) 比较不同人口和社会经济背景的肾脏接受者的自我保健实践和移植结果。 为了实现这些目标，拟议的四年纵向研究将使用多种方法进行数据收集。将通过每六个月对肾脏接受者进行访谈以及通过医疗图表审查来前瞻性地收集数据。确定与更好的移植物存活相关的社会文化和经济过程对于以下方面非常重要：a) 预防肾排斥，b) 制定合规干预措施，c) 通过教育为移植候选人做好准备，d) 评估旨在防止肾移植财务障碍的卫生政策，以及 e) 消除长期肾脏存活率的差异