Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: A combined stepped-care and matching model
Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: A combined stepped-care and matching model
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DOI：
10.1007/bf02895291
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发表时间：
1996-09-01
影响因子：
3.8
通讯作者：
Velicer, W
中科院分区：
文献类型：
--
作者：
Abrams, DB;Orleans, CT;Velicer, W
将预防纳入主流保健的势头越来越大。三十年来对烟草依赖的研究可以为这种整合的概念，临床，经济和服务提供挑战提供见解。生物科学，认知行为，临床治疗结果和公共卫生领域的选择性审查。关键的概念问题进行了探讨，以合理的成本为一般人群的成年吸烟者提供优质的戒烟治疗。一个全面的模式，为成人戒烟治疗的发展。该模式包括一个总体的公共卫生方法，重点是提高动机水平，从低动机戒烟到高动机。提出了一个共同的结果指标的整体影响，以促进临床和公共卫生干预措施之间的比较。然后对吸烟者进行评估，并将其分为最小、中等和最大强度和成本的三个治疗步骤之一。吸烟者在人口和个人层面的个体差异也被考虑在内，作为分步干预措施内和跨分步干预措施的定制或匹配战略的一部分。吸烟者档案包括社会文化，尼古丁依赖和合并症因素。其结果是一个混合阶梯护理匹配模型。该模型有助于说明未来烟草依赖研究和实践所面临的一些需求和挑战。比较烟草控制和其他预防性医学实践的成本，每质量调整生命年节省。管理式医疗的障碍和机会进行了探讨，这里确定的概念原则可以作为一个路标，将其他预防医学计划纳入不断发展的管理式医疗保健系统。
There is an increasing momentum to integrate prevention into mainstream health care. Three decades of research on tobacco dependence can provide insights into the conceptual, clinical, economic, and service delivery challenges to such an integration. Biological sciences, cognitive-behavioral, clinical treatment outcome, and public health arenas are selectively reviewed. The key conceptual issues are explored relevant to the optimal delivery of quality smoking cessation treatments for the general population of adult smokers at reasonable cost. A comprehensive model for adult smoking cessation treatment is developed. The model consists of an overarching public health approach, focusing on enhancing motivational level from low motivation to quit to high motivation. A common outcome metric of overall impact is proposed to facilitate comparisons between clinical and public health interventions. Smokers are then assessed and triaged into one of three treatment steps of minimal, moderate, and maximal intensity and cost. Smoker individual differences at both the population and individual level are also taken into account as part of a tailoring or matching strategy within and across the stepped interventions. Smoker profiles include sociocultural, nicotine dependence, and comorbidity factors. The result is a hybrid stepped-care matching model. The model serves to illustrate some of the needs and challenges facing future tobacco dependence research and practice. Comparisons are made between tobacco control and other preventive medicine practices in terms of cost per quality adjusted life-year saved. The barriers and opportunities under managed care are explored, The conceptual principles identified here could be used as a guidepost for integrating other preventive medicine programs into the evolving managed health care system.