A comprehensive electronic health record-enabled smoking treatment program: Evaluating reach and effectiveness in primary care in a multiple baseline design.
A comprehensive electronic health record-enabled smoking treatment program: Evaluating reach and effectiveness in primary care in a multiple baseline design.
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DOI：
10.1016/j.ypmed.2022.107101
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发表时间：
2022-12
影响因子：
5.1
通讯作者：
Fiore, Michael C.
中科院分区：
文献类型：
--
作者：
McCarthy, Danielle E.;Baker, Timothy B.;Zehner, Mark E.;Adsit, Robert T.;Kim, Nayoung;Zwaga, Deejay;Coates, Katherine;Wallenkamp, Hannah;Nolan, Margaret;Steiner, Margaret;Skora, Amy;Kastman, Christian;Fiore, Michael C.
存在有效的戒烟治疗方法，但未得到充分利用。积极的慢性护理方法可以提高戒烟治疗的覆盖面，并降低卫生保健系统中的吸烟率。本实用研究评估了一项基于人群的综合烟草干预计划（CTIP），该计划在美国威斯康辛州麦迪逊市的所有(6)个成人初级保健诊所实施，评估了治疗范围、公平性和促进戒烟的有效性。CTIP分三波启动，每波有两个诊所，每波有多个基线设计。电子健康记录（EHR）工具促进了临床医生提供的药物治疗和咨询；指导烟草保健管理人员向所有吸烟患者进行电话外展；并促使使用选择退出方法对吸烟登记的所有患者进行多方法批量外展。分析了2018年1月至2020年2月期间6894名成年患者的电子病历数据，以评估CTIP的覆盖率和有效性。在CTIP启动后，6家诊所中有5家的戒烟治疗覆盖率显着增加，并且在CTIP活跃与不活跃的诊所中，戒烟治疗覆盖率显着增加[比值比（OR）范围= 2.0-3.0]。在活跃诊所和不活跃诊所，从目前吸烟状态转变为以前吸烟状态的比率也更高（OR范围= 2.2-10.5）。在历史上服务不足的群体中，电话治疗的覆盖率特别高，包括非裔美国人、西班牙裔和符合医疗补助条件的患者。针对所有吸烟患者实施一项全面的、可选择退出的慢性护理计划，与药物治疗和咨询服务的提供以及戒烟率的增加有关。积极主动的外联可能有助于缩小在获得治疗方面的差距。
Effective treatments for smoking cessation exist but are underused. Proactive chronic care approaches may enhance the reach of cessation treatment and reduce the prevalence of smoking in healthcare systems. This pragmatic study evaluated a population-based Comprehensive Tobacco Intervention Program (CTIP) implemented in all (6) adult primary care clinics in a Madison, Wisconsin, USA healthcare cooperative, assessing treatment reach, reach equity, and effectiveness in promoting smoking cessation. CTIP launched in 3 waves of 2 clinics each in a multiple baseline design. Electronic health record (EHR) tools facilitated clinician-delivered pharmacotherapy and counseling; guiding tobacco care managers in phone outreach to all patients who smoke; and prompting multimethod bulk outreach to all patients on a smoking registry using an opt-out approach. EHR data were analyzed to assess CTIP reach and effectiveness among 6894 adult patients between January 2018 and February 2020. Cessation treatment reach increased significantly after CTIP launch in 5 of 6 clinics and was significantly higher when clinics were active vs. inactive in CTIP [Odds Ratio (OR) range=2.0–3.0]. Rates of converting from current to former smoking status were also higher in active vs. inactive clinics (OR range=2.2–10.5). Telephone treatment reach was particularly high in historically underserved groups, including African-American, Hispanic, and Medicaid-eligible patients. Implementation of a comprehensive, opt-out, chronic-care program aimed at all patients who smoke was associated with increases in the rates of pharmacotherapy and counseling delivery and quitting smoking. Proactive outreach may help reduce disparities in treatment access.
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影响因子：
5.7
作者：
Flocke, Susan A.;Seeholzer, Eileen;Kaelber, David
通讯作者：
Kaelber, David
影响因子：
5.5
作者：
Baker TB;Berg KM;Adsit RT;Skora AD;Swedlund MP;Zehner ME;McCarthy DE;Glasgow RE;Fiore MC
通讯作者：
Fiore MC
影响因子：
3.6
作者：
Adsit, Robert T.;Fox, Bradley M.;Fiore, Michael C.
通讯作者：
Fiore, Michael C.
影响因子：
5.5
作者：
Fraser, David L.;Fiore, Michael C.;Baker, Timothy B.
通讯作者：
Baker, Timothy B.
影响因子：
1
作者：
Greenwood, Deborah A.;Parise, Carol A.;Buss, Kimberly A.
通讯作者：
Buss, Kimberly A.