Proactive Tobacco Treatment and Population-Level Cessation A Pragmatic Randomized Clinical Trial
Proactive Tobacco Treatment and Population-Level Cessation A Pragmatic Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2014.177
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发表时间：
2014-05-01
影响因子：
39
通讯作者：
Joseph, Anne M.
中科院分区：
文献类型：
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作者：
Fu, Steven S.;van Ryn, Michelle;Joseph, Anne M.
目前的烟草使用治疗方法需要吸烟者要求治疗或依赖提供者启动戒烟护理，因此是反应性的。大多数吸烟者没有接受包括行为咨询和药物治疗在内的循证烟草使用治疗。目的评估主动的、基于人群的戒烟护理模式对使用循证烟草戒烟治疗和人群水平戒烟率的影响（即所有吸烟者的戒烟率，包括使用和不使用治疗的吸烟者）与当前吸烟者的不同人群中的常规治疗进行比较。退伍军人战胜烟草研究，一项实用的随机临床试验，涉及18至80岁的吸烟者的人口登记。共有6400目前的吸烟者，确定使用退伍军人事务部（VA）的电子病历，随机接触前，以评估双方的影响和积极的护理interventions.INTERVENTIONS的有效性目前的吸烟者被随机分配到日常护理或积极的护理。主动护理结合（1）主动外展和（2）提供戒烟服务选择（电话或亲自）。积极主动的推广包括邮寄邀请，然后通过电话推广，以激励吸烟者寻求治疗的选择services.Main结果和措施的主要结果是6个月的长期戒烟在1年，并进行了评估，在所有目前的吸烟者，无论戒烟或治疗utilization.Results的兴趣，共有5123名参与者被纳入主要分析的后续调查。后续调查的回复率为66%。在人群水平上，主动治疗组1年时6个月的长期戒烟率为13.5%，而常规治疗组为10.9%（P = 0.02）。Logistic回归混合模型分析显示，主动护理干预对6个月的长期禁欲有显著影响（比值比[OR]，1.27 [95%CI，1.03-1.57]）。在使用基于可能性的非随机缺失模型解释无应答的分析中，主动护理对6个月长期禁欲的影响持续存在（OR，1.33 [95%CI，1.17-1.51]）。以人群为基础的戒烟护理，通过主动外展将吸烟者与循证电话或面对面戒烟服务联系起来，长期人口水平的戒烟率。
IMPORTANCE Current tobacco use treatment approaches require smokers to request treatment or depend on the provider to initiate smoking cessation care and are therefore reactive. Most smokers do not receive evidence-based treatments for tobacco use that include both behavioral counseling and pharmacotherapy.OBJECTIVE To assess the effect of a proactive, population-based tobacco cessation care model on use of evidence-based tobacco cessation treatments and on population-level smoking cessation rates (ie, abstinence among all smokers including those who use and do not use treatment) compared with usual care among a diverse population of current smokers.DESIGN, SETTING, AND PARTICIPANTS The Veterans Victory Over Tobacco Study, a pragmatic randomized clinical trial involving a population-based registry of current smokers aged 18 to 80 years. A total of 6400 current smokers, identified using the Department of Veterans Affairs (VA) electronic medical record, were randomized prior to contact to evaluate both the reach and effectiveness of the proactive care intervention.INTERVENTIONS Current smokers were randomized to usual care or proactive care. Proactive care combined (1) proactive outreach and (2) offer of choice of smoking cessation services (telephone or in-person). Proactive outreach included mailed invitations followed by telephone outreach to motivate smokers to seek treatment with choice of services.MAIN OUTCOMES AND MEASURES The primary outcome was 6-month prolonged smoking abstinence at 1 year and was assessed by a follow-up survey among all current smokers regardless of interest in quitting or treatment utilization.RESULTS A total of 5123 participants were included in the primary analysis. The follow-up survey response rate was 66%. The population-level, 6-month prolonged smoking abstinence rate at 1 year was 13.5% for proactive care compared with 10.9% for usual care (P = .02). Logistic regression mixed model analysis showed a significant effect of the proactive care intervention on 6-month prolonged abstinence (odds ratio [OR], 1.27 [95% CI, 1.03-1.57]). In analyses accounting for nonresponse using likelihood-based not-missing-at-random models, the effect of proactive care on 6-month prolonged abstinence persisted (OR, 1.33 [95% CI, 1.17-1.51]).CONCLUSIONS AND RELEVANCE Proactive, population-based tobacco cessation care using proactive outreach to connect smokers to evidence-based telephone or in-person smoking cessation services is effective for increasing long-term population-level cessation rates.