Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Efficacy.
Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Efficacy.
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初级保健中主动电子访问戒烟和慢性阻塞性肺疾病筛查：可行性、可接受性和有效性的随机对照试验。
DOI：
10.2196/38663
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发表时间：
2022-08-30
影响因子：
7.4
通讯作者：
Diaz, Vanessa A.
中科院分区：
文献类型：
--
作者：
Dahne, Jennifer;Player, Marty S.;Strange, Charlie;Carpenter, Matthew J.;Ford, Dee W.;King, Kathryn;Miller, Sarah;Kruis, Ryan;Hawes, Elizabeth;Hidalgo, Johanna E.;Diaz, Vanessa A.
关键词：
大多数患有慢性阻塞性肺疾病（COPD）的吸烟者尚未被诊断出来，这一统计数据二十多年来一直保持不变。一个双重重点的远程医疗干预，促进戒烟，同时也促进COPD筛查，可以帮助解决国家的优先事项，以改善诊断，预防，治疗和管理COPD。本研究的目的是初步评估一种综合异步戒烟和COPD筛查电子访视（电子访视），该访视可主动提供给在初级保健中接受治疗的有COPD风险的成年吸烟者。本研究的目的是（1）检查电子访视的可行性和可接受性，特别是与实验室诊断性肺功能测试（PFT）相比，（2）检查戒烟电子访视相对于常规治疗（TAU）的有效性，所有这些都在初级保健中进行。在一项随机临床试验中，125名吸烟的初级保健患者以2：1的比例随机接受主动电子访视或TAU。随机分配至电子访视条件的受试者通过初级保健中的COPD评估以识别未诊断的呼吸系统疾病和加重风险（CAPTURE）筛查COPD症状。除两次戒烟电子访视外，邀请评分≥2的患者完成家庭肺量测定和实验室PFT。戒烟电子访视评估了吸烟史和戒烟动机，并包括完成一个算法，以确定最好的食品和药物管理局批准的戒烟药物处方。主要结局包括与（1）电子访视可接受性、可行性和治疗指标相关的指标;（2）戒烟结局（戒烟药物使用、24小时戒烟尝试、吸烟减少≥ 50%、自我报告的戒烟和生化证实的戒烟）;和（3）COPD筛选结局。在分配到电子访视的85名参与者中，64名（75.3%）受邀完成基于CAPTURE的家庭肺量计和实验室内PFT。在符合肺功能测定条件的患者中，76.6%（49/64）完成了家庭肺功能测定，35.9%（23/64）完成了实验室PFT。在1个月时，所有戒烟结局均支持电子访视，对戒烟药物的使用有显著影响（比值比[OR]=3.22）。在3个月时，除24小时戒烟尝试外，所有戒烟结局均支持电子访视，对戒烟药物使用（OR=3.96）和吸烟减少（OR=3.09）具有显著影响。戒烟和COPD筛查的主动、异步电子访视可能为初级保健中的广泛干预提供一种可行、有效的方法。ClinicalTrials.gov NCT04155073; https://clinicaltrials.gov/ct2/show/NCT04155073
Most smokers with chronic obstructive pulmonary disease (COPD) have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation, while also facilitating COPD screening, could help address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of this study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit (electronic visit) that could be delivered proactively to adult smokers at risk for COPD, who are treated within primary care. The aims of this study were (1) to examine e-visit feasibility and acceptability, particularly as compared to in-lab diagnostic pulmonary function testing (PFT), and (2) to examine the efficacy of smoking cessation e-visits relative to treatment as usual (TAU), all within primary care. In a randomized clinical trial, 125 primary care patients who smoke were randomized 2:1 to receive either proactive e-visits or TAU. Participants randomized to the e-visit condition were screened for COPD symptoms via the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE). Those with scores ≥2 were invited to complete both home spirometry and in-lab PFTs, in addition to two smoking cessation e-visits. Smoking cessation e-visits assessed smoking history and motivation to quit and included completion of an algorithm to determine the best Food and Drug Administration–approved cessation medication to prescribe. Primary outcomes included measures related to (1) e-visit acceptability, feasibility, and treatment metrics; (2) smoking cessation outcomes (cessation medication use, 24-hour quit attempts, smoking reduction ≥50%, self-reported abstinence, and biochemically confirmed abstinence); and (3) COPD screening outcomes. Of 85 participants assigned to the e-visits, 64 (75.3%) were invited to complete home spirometry and in-lab PFTs based on CAPTURE. Among those eligible for spirometry, 76.6% (49/64) completed home spirometry, and 35.9% (23/64) completed in-lab PFTs. At 1 month, all cessation outcomes favored the e-visit, with a significant effect for cessation medication use (odds ratio [OR]=3.22). At 3 months, all cessation outcomes except for 24-hour quit attempts favored the e-visit, with significant effects for cessation medication use (OR=3.96) and smoking reduction (OR=3.09). A proactive, asynchronous e-visit for smoking cessation and COPD screening may offer a feasible, efficacious approach for broad interventions within primary care. ClinicalTrials.gov NCT04155073; https://clinicaltrials.gov/ct2/show/NCT04155073
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DOI：
10.3109/15412555.2015.1043424
发表时间：
2015-11-02
影响因子：
2.2
作者：
Pleasants, Roy A.;Heidari, Khosrow;Kraft, Monica
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影响因子：
120.7
作者：
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影响因子：
4.7
作者：
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McClure, Erin A.
影响因子：
4.4
作者：
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DOI：
10.1164/rccm.201603-0622oc
发表时间：
2017-03-15
影响因子：
24.7
作者：
Martinez, Fernando J.;Mannino, David;Yawn, Barbara P.
通讯作者：
Yawn, Barbara P.