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

描述（由申请人提供）：良好的血糖控制、血脂控制或血压（BP）控制可以通过坚持推荐的护理来实现，包括药物、预防保健和生活方式的改变。良好的生理控制，反过来，降低进展为急性终末器官疾病的风险，如心血管疾病（CVD），或肥胖。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。适应负荷是一种量化多个身体系统累积应力相关生理失调的方法。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因素——经济环境（高成本分担、经济剥夺）、社会压力和个人痛苦——也可能通过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验证我们的工作假设，即坚持1)推荐的生活方式和2)处方药物治疗方案可以调节心理社会压力和个人痛苦与适应负荷的关联。主要研究人群为25-59岁的乔治亚州凯萨医疗机构（Kaiser Permanente Georgia， KPGA）的入组者，他们参加了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，并在2006年继续入组进行适应负荷评估（N= 1915）。根据PA-06-151的要求，拟议的研究将使用现有的数据集（调查结果和计算机化的管理数据）来创建一个协变量丰富的数据集，以充分回答当前社会心理压力源、适应负荷和疾病进展之间关系模型未解决的重要问题。适应负荷的程度及其随后对疾病进展的影响是否部分由社会心理压力源对依从推荐护理方案的影响介导？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个机制是减少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以通过承认社会支持和压力缓解的好处来纠正，这些好处是由政府机构、社区组织和公共和私人保险计划提供的健康促进计划的课程。

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.