Self-Care & Outcomes Among Kidney Transplant Recipients

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，但移植后前10年的肾损失仍然是一个严重的问题。这一问题迫在眉睫，因为种族/族裔和社会经济差异持续存在于肾脏存活率，造成移植结果的不平等。这种存活率差异的一个可能解释是遵从性和症状管理的自我护理实践中的社会不公平。自我护理对肾脏的生存至关重要。但是，用于自我护理的资源(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)，只要新的肾脏功能正常，只有残疾的肾脏接受者才能获得充分的支持，但大多数肾脏接受者没有残疾，因此财政支持仍然有限。这一限制可能导致稀缺肾脏的浪费，因为它阻止患者在三年后维持肾脏。因此，自我照顾的能力和做法因种族/族裔和保险状况而异。 这项拟议的跨学科研究将考察肾脏接受者在保险公司提供的有限财政支持的背景下，为保持肾脏健康而动员的社会、文化和经济战略和资源。这项研究的具体目的是：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护理和经济维持肾移植的做法；3)衡量受者的健康信念和自我护理做法对移植结果的影响；以及4)比较不同人口统计和社会经济背景的肾移植受者的自我护理做法和移植结果。 为了实现这些目标，拟议的为期四年的纵向研究将使用多种方法收集数据。数据将通过每六个月与肾脏接受者的访谈和病历审查来前瞻性地收集。确定与更好的移植肾存活率相关的社会文化和经济过程对于：a)预防肾排斥反应，b)设计合规干预措施，c)通过教育为移植对象做好准备，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距，这一点很重要

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