Comparing an opt-out to an opt-in approach for smoking cessation in VA primary care clinics

退伍军人事务部初级保健诊所选择退出与选择加入戒烟方法的比较

• 批准号: 10186542
• 负责人: STEVEN FU
• 金额: --
• 依托单位: VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186542
• 关键词: Abstinence; Affect; Ambulatory Care; Behavior Therapy; Behavioral; Belief; Caring; Cause of Death; Characteristics; Clinic; Costs and Benefits; Counseling; Diabetes Mellitus; Enrollment; Health Personnel; Health care facility; Health system; Healthcare; Healthcare Systems; Human; Hypertension; Intervention; Methods; Organ Donations; Patients; Pharmaceutical Preparations; Population; Pregnant Women; Primary Health Care; Provider; Randomized; Recommendation; Reporting; Research; Sexually Transmitted Diseases; Site; Smoker; Smoking; Structure; System; Telephone; Testing; Text Messaging; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; base; behavioral economics; behavioral study; compare effectiveness; cost; cost effective; effectiveness implementation study; evidence base; population based; pressure; programs; quitline; recruit; research study; satisfaction; screening; smoking cessation; telephone coaching

ABSTRACT Smoking is the leading preventable cause of death in the US, and health care systems are able to reach a large number of smokers and effectively engage them into evidence based tobacco treatment. Effective cessation approaches include medications and behavioral treatment (including face-to-face counseling, telephone counseling and text messaging). While delivery of smoking cessation medications has increased, it has proven more difficult to increase the delivery of behavioral treatments. Within primary care, health care providers are effective at counseling smokers to quit, yet few providers actually deliver longitudinal counseling due to time pressures and competing priorities. The two main evidence-based approaches available in the U.S. for behavioral tobacco dependence treatment include Quitlines (to deliver telephone counseling) and text messaging programs. Tobacco Quitlines are effective and our prior studies have explored different approaches to increasing use of Quitlines, yet many questions remain about how best to do this within health care systems. Similarly, text messaging is effective at helping smokers to quit, but is rarely used in health care. While 11% of smokers reported having used a quit smoking program that involves text messaging, no studies to date have examined health care-based approaches to increase engagement in text messaging programs, such as VA’s SmokefreeVET. Our prior research shows that nearly all smokers are capable of receiving text messages and most feel that it would help them to quit. National mandates call for health care systems to refer all smokers to treatment, yet there is little guidance on how to achieve this objective. Studies from behavioral economics and other fields suggest that how the referral is framed is extremely important. Systems typically use an opt-in approach where the default is “no treatment”, unlike conditions such as diabetes or hypertension where we treat people unless they opt-out of treatment. An opt-out approach has proven much more effective in other settings, such as organ donation, screening for sexually transmitted diseases and recruitment for research studies. Aside from an uncontrolled UK study among pregnant women, no studies have tested an opt-out approach for smokers in ambulatory care. We propose a Type I hybrid effectiveness/implementation study to evaluate two population-based approaches for increasing use of Quitlines and text messaging at two VA sites. Specifically, we will test the default bias, examining whether an opt-out approach to referral is more effective than an opt-in approach. We will randomly assign teams to either an opt-out or opt-in approach to referring smokers to treatment. In the opt- out approach, the default is that everyone is referred to treatment unless they actively choose not to be. In the opt-in approach, people are offered treatment but must actively choose to enroll in it. Our specific aims are: (1) To compare the effectiveness of an opt-out approach to an opt-in approach at helping patients quit smoking in primary care; (2) To compare the costs and benefits of an opt-out approach to an opt-in approach to smoking cessation in primary care.; and (3) To evaluate patient and staff factors affecting implementation of the opt-out and opt-in interventions in primary care. If effective, this approach would provide a simple, easily scalable method for increasing engagement in behavioral treatment and for boosting long-term abstinence rates.

摘要 在美国，吸烟是导致死亡的主要可预防原因，卫生保健系统能够 接触大量吸烟者，并有效地使他们参与循证烟草治疗。 有效的戒烟方法包括药物和行为治疗（包括面对面）。 咨询、电话咨询和短信）。虽然提供戒烟药物 增加，它已被证明更难增加行为治疗的交付。在初级保健中， 卫生保健提供者在建议吸烟者戒烟方面是有效的，但很少有提供者实际上提供纵向的 由于时间压力和竞争的优先事项。两种主要的循证方法 在美国可用于行为烟草依赖治疗的药物包括戒烟热线（提供电话 咨询）和短信程序。戒烟热线是有效的，我们以前的研究已经探索了 不同的方法来增加戒烟热线的使用，但许多问题仍然是如何最好地做到这一点， 医疗保健系统。同样，短信在帮助吸烟者戒烟方面也很有效，但很少用于 保健虽然11%的吸烟者报告说他们使用了包括短信在内的戒烟计划， 到目前为止，还没有研究检查基于医疗保健的方法来增加短信的参与度 例如，在美国的SmokefreeVET。我们先前的研究表明，几乎所有的吸烟者都有能力 大多数人认为这将有助于他们戒烟。国家授权要求保健 尽管有一些国家制定了将所有吸烟者转介接受治疗的系统，但在如何实现这一目标方面却几乎没有指导。研究 来自行为经济学和其他领域的研究表明，如何构建推荐非常重要。 系统通常使用一种选择加入的方法，默认为“不治疗”，而不像 糖尿病或高血压，我们治疗的人，除非他们选择退出治疗。选择退出的方法 在其他情况下证明更有效，如器官捐赠，筛查性传播疾病 疾病和招募研究人员。除了英国一项针对孕妇的非对照研究外， 没有任何研究测试过在门诊护理中吸烟者选择退出的方法。 我们提出了一个I型混合有效性/实施研究，以评估两个基于人口的 在两个退伍军人事务部站点增加使用戒烟热线和短信的方法。具体来说，我们将测试 默认偏见，检查选择退出的方法是否比选择加入的方法更有效。我们 将随机分配团队选择退出或选择参与的方法来介绍吸烟者接受治疗。在选择- 在这种方法中，默认情况是每个人都被转诊治疗，除非他们主动选择不接受治疗。在 选择参加的方法，人们被提供治疗，但必须积极选择参加。 我们的具体目标是：（1）比较选择不参与和选择参与的有效性， 帮助病人戒烟的初级保健;（2）比较成本和效益的选择退出的方法， 在初级保健中选择戒烟的方法。（3）评估患者和工作人员因素影响 在初级保健中实施“选择退出”和“选择加入”干预措施。 如果有效，这种方法将提供一种简单、易于扩展的方法， 行为治疗和提高长期戒烟率。