Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers.
Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers.
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DOI：
10.1007/s11606-016-3687-1
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发表时间：
2016-08
影响因子：
5.7
通讯作者：
Fu SS
中科院分区：
文献类型：
--
作者：
Danan ER;Joseph AM;Sherman SE;Burgess DJ;Noorbaloochi S;Clothier B;Japuntich SJ;Taylor BC;Fu SS
目前的指南建议提供者评估吸烟者的戒烟准备，然后为计划戒烟的吸烟者提供戒烟治疗，并为不计划戒烟的吸烟者提供激励干预。我们检查了基线变化阶段（SOC）、治疗利用和戒烟之间的关系，以确定主动戒烟干预的效果是否取决于吸烟者的戒烟动机水平。多中心随机对照试验的二次分析。在四个退伍军人事务部（VA）医疗中心，共有3006名年龄在18-80岁的吸烟者。干预措施：主动治疗包括主动外展（邮寄邀请，然后电话外展），提供戒烟服务（电话或面对面），并获得药物治疗。家庭护理参与者可以获得VA戒烟服务和州电话戒烟热线。使用戒烟准备阶梯测量基线SOC，并在1年时自我报告6个月延长戒烟。基线时，35.8%的吸烟者处于准备状态，38.2%处于考虑状态，26.0%处于考虑前状态。SOC和治疗组之间的总体相互作用不具有统计学显著性（p = 0.30）。在准备吸烟者中，21.1%的主动护理参与者实现了6个月的长期戒烟，而常规护理参与者为13.1%（OR，1.8 [95%CI，1.2-2.6]）。同样，主动护理增加了吸烟者在考虑中的戒烟率（11.0% vs. 6.5%; OR，1.8 [95%CI，1.1-2.8]）。考虑前吸烟者戒烟率相似（5.3% vs. 5.6%; OR，0.9 [95%CI，0.5-1.9]）。在每个阶段内，与常规护理相比，采用更高的SOC和主动护理的戒烟治疗增加。大多数男性参与者限制了普遍性。随机化未按SOC分层。在所有SOC中，与常规护理相比，主动护理增加了治疗吸收。主动护理增加了吸烟者在准备和考虑中的戒烟率，但在考虑前没有。主动为所有SOC的吸烟者提供戒烟治疗将增加治疗利用率和人群水平的戒烟。
Current guidelines advise providers to assess smokers’ readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit. We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers’ level of motivation to quit. Secondary analysis of a multicenter randomized controlled trial. A total of 3006 current smokers, aged 18–80 years, at four Veterans Affairs (VA) medical centers. Interventions: Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines. Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year. At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p = 0.30). Among smokers in preparation, 21.1 % of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1 % of usual care participants (OR, 1.8 [95 % CI, 1.2–2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0 % vs. 6.5 %; OR, 1.8 [95 % CI, 1.1–2.8]). Smokers in precontemplation quit smoking at similar rates (5.3 % vs. 5.6 %; OR, 0.9 [95 % CI, 0.5–1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care. Mostly male participants limits generalizability. Randomization was not stratified by SOC. Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation.