An effectiveness-implementation hybrid trial of phone-based tobacco cessation interventions in the Lebanese primary healthcare system: protocol for project PHOENICS.
An effectiveness-implementation hybrid trial of phone-based tobacco cessation interventions in the Lebanese primary healthcare system: protocol for project PHOENICS.
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DOI：
10.1186/s43058-023-00456-w
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发表时间：
2023-06-26
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烟草使用仍然是世界上可预防疾病、残疾和死亡的主要原因。黎巴嫩的烟草使用负担特别高。世界卫生组织赞同将戒烟建议纳入初级保健环境，并将方便和免费的电话咨询和低成本药物治疗作为人群烟草依赖治疗的标准做法。虽然这些干预措施可以增加获得烟草治疗的机会，并且与其他干预措施相比具有很高的成本效益，但其证据基础主要来自高收入国家，很少在低收入和中等收入国家进行评估。在黎巴嫩，建议的干预措施没有像在其他资源匮乏的环境中那样被纳入初级保健的常规部分。解决这一证据与实践之间的差距需要研究多层次的干预措施和背景因素，以便在低资源环境中实施综合，可扩展和可持续的戒烟治疗。本研究的目的是评估黎巴嫩国家初级卫生保健网络内的初级卫生保健中心实施循证烟草治疗的有前途的多组分干预措施的比较有效性。我们将调整和调整现有的面对面戒烟计划，为黎巴嫩的吸烟者提供电话咨询。然后，我们将在24家诊所的1500名患者中进行一项三臂分组随机试验，比较（1）询问烟草使用情况;建议戒烟;协助简短咨询（AAA）作为标准护理;（2）询问;建议;连接到基于电话的咨询（AAC）;（3）AAC +尼古丁替代疗法（NRT）。我们还将评估实施过程，以衡量影响实施的因素。我们的中心假设是，将患者与NRT的电话咨询联系起来是最有效的选择。这项研究将以探索、准备、实施和维持框架为指导，并得到普罗克特实施成果框架的支持。该项目通过开发和测试根据具体情况定制的多层次干预措施，同时优化实施成功率和可持续性，解决了在低资源环境下提供烟草依赖治疗方面的实证与实践差距。这项研究具有重要意义，因为它有可能指导大规模采用具有成本效益的战略，在资源匮乏的环境中实施烟草依赖治疗，从而减少与烟草有关的发病率和死亡率。ClinicalTrials.gov，NCT 05628389，于2022年11月16日注册。在线版本包含补充材料，可通过10.1186/s43058-023-00456-w获得。
Tobacco use remains the leading cause of preventable disease, disability, and death in the world. Lebanon has an exceptionally high tobacco use burden. The World Health Organization endorses smoking cessation advice integrated into primary care settings as well as easily accessible and free phone-based counseling and low-cost pharmacotherapy as standard of practice for population-level tobacco dependence treatment. Although these interventions can increase access to tobacco treatment and are highly cost-effective compared with other interventions, their evidence base comes primarily from high-income countries, and they have rarely been evaluated in low- and middle-income countries. Recommended interventions are not integrated as a routine part of primary care in Lebanon, as in other low-resource settings. Addressing this evidence-to-practice gap requires research on multi-level interventions and contextual factors for implementing integrated, scalable, and sustainable cessation treatment within low-resource settings. The objective of this study is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based tobacco treatment in primary healthcare centers within the Lebanese National Primary Healthcare Network. We will adapt and tailor an existing in-person smoking cessation program to deliver phone-based counseling to smokers in Lebanon. We will then conduct a three-arm group-randomized trial of 1500 patients across 24 clinics comparing (1) ask about tobacco use; advise to quit; assist with brief counseling (AAA) as standard care; (2) ask; advise; connect to phone-based counseling (AAC); and (3) AAC + nicotine replacement therapy (NRT). We will also evaluate the implementation process to measure factors that influence implementation. Our central hypothesis is that connecting patients to phone-based counseling with NRT is the most effective alternative. This study will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, supported by Proctor’s framework for implementation outcomes. The project addresses the evidence-to-practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and testing contextually tailored multi-level interventions while optimizing implementation success and sustainability. This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for implementing tobacco dependence treatment in low-resource settings, thereby reducing tobacco-related morbidity and mortality. ClinicalTrials.gov, NCT05628389, Registered 16 November 2022. The online version contains supplementary material available at 10.1186/s43058-023-00456-w.