Offering Population-Based Tobacco Treatment in a Healthcare Setting A Randomized Controlled Trial
Offering Population-Based Tobacco Treatment in a Healthcare Setting A Randomized Controlled Trial
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DOI：
10.1016/j.amepre.2011.07.022
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发表时间：
2011-11-01
影响因子：
5.5
通讯作者：
Mort, Elizabeth
中科院分区：
文献类型：
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作者：
Rigotti, Nancy A.;Bitton, Asaf;Mort, Elizabeth
背景：医疗保健系统是向烟草使用者提供治疗的关键渠道。以临床为基础的简短干预措施是有效的，但并不可靠。人口管理策略可能会改善医疗系统中烟草治疗的提供。目的：测试以基于人口的直接吸烟者(DTS)推广提供容易获得的免费烟草治疗来补充以诊所为基础的护理的有效性。设计：随机对照试验，于2009-2010年进行，地点/参与者：共有590名吸烟者在马萨诸塞州Revere的一家社区卫生中心登记接受初级保健。干预：每月三封信，向烟草协调员提供免费电话咨询，该协调员提供免费治疗，包括最多8周的尼古丁贴片(NRT)和主动转介到州戒烟热线接受多节咨询。主要结果衡量标准：在3个月的随访中使用任何烟草治疗(主要结果)和戒烟；结果：在413名符合条件的吸烟者中，DTS组43人(10.4%)接受治疗；42人(98%)要求NRT，30人(70%)要求咨询。在对年龄、性别、种族、保险、糖尿病和冠心病进行Logistic回归调整的意向治疗分析中，与对照组相比，DTS组使用NRT的比例更高(11.6%比3.9%，OR=3.47；95%CI=1.52，7.92)或任何烟草治疗(14.5%vs 7.3%，OR=1.95，95%CI=1.04，3.65)，过去7天戒烟(5.3%vs 1.1%，OR=5.35，95%CI=1.23，22.32)和过去30天戒烟(4.1%vs 0.6%，OR=8.25，95%CI=1.08，63.01)。干预没有增加吸烟者使用咨询(1.7%比1.1%)或非NRT药物(3.6%比3.9%)。估计每次戒烟的增量成本为464美元。结论：在健康中心为吸烟者提供免费烟草治疗的基于人群的推广是一种可行的、具有成本效益的方法，可以扩大治疗范围(主要是NRT)并增加短期戒烟率。试验注册：这项研究在ClinicalTrials.gov NCT01321944注册。(Am J Prev Med 2011；41(5)：498-503)(C)2011年美国预防医学杂志
Background: The healthcare system is a key channel for delivering treatment to tobacco users. Brief clinic-based interventions are effective but not reliably offered. Population management strategies might improve tobacco treatment delivery in a healthcare system.Purpose: To test the effectiveness of supplementing clinic-based care with a population-based direct-to-smoker (DTS) outreach offering easily accessible free tobacco treatment.Design: Randomized controlled trial, conducted in 2009-2010, comparing usual clinical care to usual care plus DTS outreach.Setting/participants: A total of 590 smokers registered for primary care at a community health center in Revere MA.Interventions: Three monthly letters offering a free telephone consultation with a tobacco coordinator who provided free treatment including up to 8 weeks of nicotine patches (NRT) and proactive referral to the state quitline for multisession counseling.Main outcome measures: Use of any tobacco treatment (primary outcome) and tobacco abstinence at the 3-month follow-up; cost per quit.Results: Of 413 eligible smokers, 43 (10.4%) in the DTS group accepted the treatment offer; 42 (98%) requested NRT and 30 (70%) requested counseling. In intention-to-treat analyses adjusted by logistic regression for age, gender, race, insurance, diabetes, and coronary heart disease, a higher proportion of the DTS group, compared to controls, had used NRT (11.6% vs 3.9%, OR = 3.47; 95% CI = 1.52, 7.92) or any tobacco treatment (14.5% vs 7.3%, OR = 1.95, 95% CI = 1.04, 3.65) and reported being tobacco abstinent for the past 7 days (5.3% vs 1.1%, OR = 5.35, 95% CI = 1.23, 22.32) and past 30 days (4.1% vs 0.6%, OR = 8.25, 95% CI = 1.08, 63.01). The intervention did not increase smokers' use of counseling (1.7% vs 1.1%) or non-NRT medication (3.6% vs 3.9%). Estimated incremental cost per quit was $464.Conclusions: A population-based outreach offering free tobacco treatment to smokers in a health center was a feasible, cost-effective way to increase the reach of treatment (primarily NRT) and to increase short-term quit rates.Trial registration: This study is registered at Clinicaltrials.gov NCT01321944. (Am J Prev Med 2011;41(5):498-503) (C) 2011 American Journal of Preventive Medicine