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

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，减弱发展为急性终末器官疾病，如心血管疾病（CVD）或肥胖症的风险。然而，许多患者不遵守其规定的治疗方案，并表现出生理失调。非稳态负荷是量化多个身体系统中累积的应激相关生理失调的量度。持续紧张的心理社会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-经济状况（高成本分摊，经济剥夺），社会压力和个人痛苦-也可能通过其对不遵守推荐护理的影响间接影响生理失调。我们提出的研究的主要目的是检验我们的工作假设，即坚持1）推荐的生活方式和2）处方的药物治疗方案介导了心理社会压力和个人痛苦与非稳态负荷的关联。主要研究人群将是25-59岁的Kaiser Permanente格鲁吉亚（KPGA）入组者，他们对2005年的心理社会环境和生活方式（包括休闲体育活动和饮食摄入）调查做出了回应，并在2006年继续入组进行非稳态负荷评估（N= 1，915）。与PA-06-151的要求一致，拟定研究将使用现有数据集（调查结果和计算机化管理数据）创建一个协变量丰富的数据集，该数据集有足够的把握度回答当前心理社会应激源、非稳态负荷和疾病进展相关模型未回答的重要问题。非稳态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应激源对推荐护理方案依从性的影响介导？公共卫生相关性：紧张的人际关系和个人痛苦和焦虑可能导致不良健康结果的一种机制是通过降低患者对推荐护理的依从性。如果是这样的话，不遵守推荐的护理可能会得到纠正，承认社会支持的好处和缓解压力的课程中提供的健康促进计划，通过政府机构，社区组织，以及公共和私人保险计划。

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.