Leveraging Community Pharmacists to Optimize Smoking Cessation Services for Rural Smokers in Appalachia

利用社区药剂师优化阿巴拉契亚农村吸烟者的戒烟服务

• 批准号: 10551936
• 负责人: Melissa Ashley Little
• 金额: $ 101.74万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-08 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10551936
• 关键词: Abstinence; Address; Adherence; Adoption; Affect; Appalachian Region; Area; Biochemical; Chronic Disease; Clinical; Code; Communities; Community Pharmacy; Counseling; Diabetes Mellitus; Documentation; Effectiveness; Face; Financial compensation; Focus Groups; Foundations; Future; Health; Health Promotion; Hypertension; Insurance Carriers; Intervention; Maintenance; Malignant Neoplasms; Medication Management; Methods; Modeling; National Cancer Institute; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Policies; Population; Prevalence; Primary Health Care; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Resources; Risk Factors; Rural; Rural Appalachia; Rural Population; Services; Smoker; Smoking; Smoking Cessation Intervention; Statutes and Laws; Surveys; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Tobacco-Related Carcinoma; Update; base; cigarette smoking; cost; effectiveness evaluation; evidence base; experimental study; follow-up; high risk; implementation evaluation; implementation fidelity; medically underserved; medication compliance; nicotine gum; nicotine replacement; parity; post implementation; primary care setting; primary outcome; programs; quitline; recruit; relative cost; rural area; smoking cessation; smoking-related cancer; text messaging intervention; underserved area; underserved rural area; urban area

Rural Appalachian populations have the highest rates of cigarette smoking in the U.S. and are disproportionately affected by tobacco-related cancers. Publicly available smoking cessation resources (e.g., state quitlines, text-based interventions, nicotine replacement therapy [NRT]) are under-utilized by rural Appalachian smokers. Furthermore, rural Appalachia is medically underserved; thus, smoking cessation services within primary care settings face additional barriers. Community pharmacists, with their centralized placement in local communities and clinical expertise, are ideally situated to build capacity in underserved areas such as rural Appalachia to enhance existing smoking cessation resources for smokers. Research on pharmacist-delivered smoking cessation interventions is limited and does not provide for documentation and billing to compensate pharmacists for their time spent counseling patients. Medication Therapy Management (MTM), a pharmacist-delivered medication adherence approach that allows pharmacists to receive compensation for providing medication expertise, could be leveraged to promote smoking cessation. To address this gap, we developed an MTM intervention, QuitAid, to increase smoking cessation among rural smokers. QuitAid was based on a medication adherence intervention shown to be efficacious in a quitline setting. The purpose of the proposed study is to use a pragmatic approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to identify the essential components of an effective smoking cessation program that can easily integrate within community pharmacies in underserved rural areas. Smokers (n=768) recruited through 14 community pharmacies in rural Appalachia will be randomized in a 25 full factorial experiment to the following five treatments: (1) QuitAid (Yes vs. No), (2) tobacco quitline (Yes vs. No), (3) SmokefreeTXT (Yes vs. No), (4) Combination NRT Gum + NRT Patch (vs. NRT patch alone), and/or (5) 8 weeks of NRT (vs. standard 4 weeks). The primary outcome is biochemically- confirmed point prevalence abstinence at the 6-month follow-up. We will also assess implementation, including relative cost, as well as facilitators and barriers of reach, adoption, and maintenance of QuitAid and standard, evidence-based tobacco treatments through an ask-advise-connect method in community pharmacies. Our main hypothesis is that a smoking cessation MTM will increase smoking cessation and enhance reach and adherence to publicly available smoking cessation resources in medically underserved rural areas. The proposed study will: (1) provide foundational evidence for leveraging community pharmacists in underserved and rural areas to promote utilization of existing evidence-based tobacco cessation resources through enhanced MTM support, (2) inform updated national guidance on treating rural smokers, and (3) aid state legislation efforts related to pharmacy smoking cessation programs and policies. Ultimately, this research will inform strategies for smoking cessation in rural areas, such that cancer rates achieve parity with urban areas.

阿巴拉契亚农村人口的吸烟率是美国最高的， 不成比例地受到烟草相关癌症的影响。公共可用的戒烟资源(例如， 国家戒烟电话、基于文本的干预、尼古丁替代疗法[NRT])在农村地区未得到充分利用 阿巴拉契亚吸烟者。此外，阿巴拉契亚乡村的医疗服务不足；因此，戒烟 初级保健环境中的服务面临更多障碍。社区药剂师，他们的 集中安置在当地社区和临床专业知识，是建设能力的理想地点 在阿巴拉契亚农村等服务不足的地区，加强现有的戒烟资源，用于 吸烟者。关于药剂师提供的戒烟干预措施的研究是有限的，并且没有提供 以获得文件和账单，以补偿药剂师花费在咨询患者上的时间。用药 治疗管理(MTM)，一种药剂师提供的药物依从性方法，允许药剂师 以获得提供药物专业知识的补偿，可以被用来促进戒烟。 为了解决这一差距，我们开发了一种MTM干预措施Quitaid，以促进农村地区的戒烟 吸烟者。Quitaid基于一种药物依从性干预，显示出在戒毒线上是有效的 布景。拟议研究的目的是使用务实的方法，以REACH为指导， 有效性、采用、实施和维护(RE-AIM)框架，以确定必要的 有效戒烟计划的组成部分，可轻松整合到社区药店 在服务不足的农村地区。通过阿巴拉契亚农村的14家社区药店招募的吸烟者(n=768) 将在25个完全析因实验中随机分为以下五个处理：(1)Quitaid(是与否)，(2) 烟草精氨酸(是与否)、(3)无烟TXT(是与否)、(4)NRT口香糖+NRT贴片(与 NRT贴片)和/或(5)8周的NRT(与标准的4周相比)。主要的结果是生化的- 在6个月的随访中确认戒断点的患病率。我们还将评估执行情况，包括 相对成本，以及Quitaid和标准的推广、采用和维护的促进者和障碍， 在社区药房通过询问-建议-联系的方法进行循证烟草治疗。我们的 主要假设是，戒烟的MTM将增加戒烟并增强伸展能力和 坚持在医疗服务不足的农村地区公开提供戒烟资源。这个 拟议的研究将：(1)为在服务不足的地区利用社区药剂师提供基础证据 和农村地区促进现有循证戒烟资源的利用 加强MTM支持，(2)通报关于治疗农村吸烟者的最新国家指南，以及(3)援助国家 与药房戒烟计划和政策相关的立法工作。最终，这项研究将 为农村地区的戒烟战略提供信息，使癌症发病率达到与城市地区相同的水平。