Implementation of Ask-Advise-Connect in a safety net healthcare system: quitline treatment engagement and smoking cessation outcomes
Implementation of Ask-Advise-Connect in a safety net healthcare system: quitline treatment engagement and smoking cessation outcomes
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DOI：
10.1093/tbm/iby108
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发表时间：
2020-02-01
影响因子：
3.6
通讯作者：
Vidrine, Jennifer, I
中科院分区：
文献类型：
--
作者：
Pineiro, Barbara;Vidrine, Damon J.;Vidrine, Jennifer, I
Ask-Advise-Connect（AAC）旨在将初级保健环境中的吸烟者与通过州戒烟热线提供的循证烟草治疗联系起来。AAC包括培训医务人员询问吸烟状况，建议吸烟者戒烟，并通过电子健康记录中的自动链接立即将吸烟者与戒烟热线联系起来。我们在一个大型的安全网医疗保健系统中进行了一项为期34个月的实施试验，评估了AAC在促进治疗参与和戒烟方面的疗效。AAC于2013年4月至2016年2月在13个社区诊所实施，这些诊所为低收入，主要是少数种族/少数民族吸烟者提供护理。有执照的职业护士接受培训，以实施AAC作为标准护理的一部分。结果包括（a）治疗参与（即，参加治疗的已鉴定吸烟者的比例）和（B）6个月时自我报告和生化证实的戒烟。记录了218，915例独特患者的吸烟状况，40，888例报告了当前吸烟。在所有确定的吸烟者中，参加治疗的比例为11.8%。6个月时自我报告的禁欲率为16.6%，生化证实的禁欲率为4.5%。AAC作为标准护理的一部分成功实施。与文献中报道的更传统的基于尿道的方法相比，治疗参与率较高。虽然自我报告的禁欲与其他戒烟治疗研究一致，但生化证实的禁欲（戒烟研究中没有常规记录）明显较低。这种差异挑战了自我报告对于大型人群研究的充分性。需要进行更详细和全面的调查。
Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.