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: 7740392
• 负责人: DOUGLAS W ROBLIN
• 金额: $ 18.93万
• 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 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7740392
• 关键词: Acute; Address; Adherence; Adult; Affect; African American; Age; Anxiety; Attenuated; 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; Modification; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Organ; Outcome; Pathway interactions; Patients; Pharmaceutical Preparations; Physical activity; Physiological; Population; Population Study; Preventive; Psychosocial Stress; Publishing; Race; 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）：通过坚持推荐的护理，包括药物治疗、预防性护理和生活方式改变，可以实现良好的血糖控制、血脂控制或血压 (BP) 控制。良好的生理控制反过来可以降低进展为急性终末器官疾病的风险，例如心血管疾病 (CVD) 或肥胖。然而，许多患者不遵守规定的治疗方案并表现出生理失调。稳态负荷是一种量化多个身体系统累积的压力相关生理失调的指标。持续紧张的社会心理和经济环境会增加免疫反应受损、生理失调和终末器官疾病的风险。直接影响生理失调的相同因素——财务状况（高成本分摊、经济匮乏）、社会压力和个人痛苦——也可能通过影响不遵守推荐的护理而间接影响生理失调。我们提出的研究的主要目的是检验我们的工作假设，即遵守 1) 推荐的生活方式和 2) 规定的药物治疗方案可以调节社会心理压力和个人痛苦与稳态负荷之间的关系。主要研究人群为乔治亚州凯撒医疗机构 (KPGA) 25-59 岁的参与者，他们对 2005 年心理社会状况和生活方式（包括休闲体育活动和饮食摄入）的调查做出了回应，并在 2006 年仍然参加了非稳态负荷评估（N=1,915）。根据 PA-06-151 的要求，拟议的研究将使用现有数据集（调查结果和计算机化管理数据）创建一个丰富的协变量数据集，足以回答当前心理社会压力源、稳态负荷和疾病进展关联模型无法回答的重要问题。适应负荷的程度及其对疾病进展的后续影响是否部分由社会心理压力源对遵守推荐的护理方案的影响所介导？公共卫生相关性：紧张的人际关系以及个人痛苦和焦虑可能导致不良健康结果的一种机制是降低患者对推荐护理的依从性。如果是这样，通过承认政府机构、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社会支持和减轻压力的好处，可以纠正不遵守建议的护理的情况。