Hybrid Type 1 Effectiveness-Implementation Trial of a Proactive Smoking Cessation Electronic Visit for Scalable Delivery via Primary Care

主动戒烟电子就诊的混合 1 型有效性实施试验,通过初级保健进行可扩展交付

基本信息

项目摘要

ABSTRACT Cigarette smoking causes 480,000 premature deaths each year in the United States, of which 36% are due to cancer. Two-thirds of smokers want to quit, but fewer than one-third make a quit attempt using an evidence- based approach. Consequently, fewer than one in ten smokers report quitting successfully in the last year. Comprehensive dissemination strategies are needed to increase utilization of evidence-based cessation treatments and improve cessation among adult smokers. The vast majority (>70%) of smokers visit a primary care physician (PCP) at least once per year. As such, primary care offers a ripe opportunity through which to proactively deliver cessation treatment to adult smokers. All primary care practices that qualify for Centers for Medicare and Medicaid Services reimbursement are required to maintain electronic health records (EHRs) with coded smoking status data for adult patients. These data can be utilized to proactively identify smokers and deliver treatment. Our team recently completed a pilot study to develop, refine, and preliminarily evaluate a proactive asynchronous smoking cessation electronic visit (e-visit) delivered via the EHR. The goal of the e-visit is to automate best practice guidelines for cessation treatment via primary care to ensure that all smokers receive an evidence-based intervention. An initial baseline e-visit gathers information about smoking history and motivation to quit, followed by an algorithm to determine the best FDA-approved cessation medication to prescribe. A one-month follow-up e-visit assesses progress toward cessation. Clinical outcomes of our pilot (N=51) were promising. At study end (three months), e-visit participants, relative to treatment as usual (TAU), were 4.7 times more likely to have used a cessation medication, 4.1 times more likely to have reduced their cigarettes per day by >50%, and 4.2 times more likely to report 7-day point prevalence abstinence. Feasibility outcomes were similarly promising, with >85% of e-visit participants reporting that they found the e-visit easy to use, would use an e-visit again, and trusted their provider with their care during the e-visit. We now propose a Hybrid Type I effectiveness-implementation trial to comprehensively assess e-visit effectiveness relative to TAU while simultaneously evaluating implementation when delivered across primary care settings. Effectiveness outcomes will be assessed through 6-months of follow-up and include: 1) evidence-based cessation treatment utilization, 2) reduction in cigarettes per day, and 3) biochemically verified 7-day point prevalence abstinence. Implementation outcomes will be assessed at patient, provider, and organizational levels. This program of research has the potential for broad and direct benefits to: 1) smokers, who will have increased treatment access, 2) PCPs, who can more efficiently treat smokers while also having an additional reimbursable service, and 3) care systems, who can improve compliance with Joint Commission recommendations for cessation treatment.
摘要 在美国,吸烟每年导致48万人过早死亡,其中36%是由于 癌症。三分之二的吸烟者想戒烟,但只有不到三分之一的吸烟者利用证据尝试戒烟。 基于策略的方法。因此,只有不到十分之一的吸烟者报告在去年成功戒烟。 需要全面的传播战略,以增加循证戒烟的利用 治疗和改善成年吸烟者的戒烟情况。绝大多数(70%)的吸烟者会去初选 护理医生(PCP)每年至少一次。因此,初级保健提供了一个成熟的机会,通过它 主动为成年吸烟者提供戒烟治疗。符合中心资格的所有初级保健做法 联邦医疗保险和医疗补助服务报销需要维护电子健康记录(EHR) 成年患者的编码吸烟状态数据。这些数据可用于主动识别吸烟者和 提供治疗。我们的团队最近完成了一项初步研究,以开发、提炼和初步评估 通过电子健康记录提供的主动的非同步戒烟电子访问(e-view)。电子访问的目标是 是通过初级保健将戒烟治疗的最佳实践指南自动化,以确保所有吸烟者 以证据为基础的干预。最初的基线电子访问收集有关吸烟史和 戒烟动机,然后是确定FDA批准的最佳戒烟药物的算法 开药方。一项为期一个月的跟踪电子访问评估戒烟进展情况。我们飞行员的临床结果 (n=51)有希望。在研究结束时(三个月),电子访问参与者,相对于正常治疗(TAU), 有4.7倍的人使用过戒烟药物,4.1倍的人有可能减少 每天吸烟50%,报告7天戒烟率的可能性是后者的4.2倍。可行性 结果同样令人振奋,85%的电子访问参与者报告说,他们发现电子访问很容易 使用,将再次使用电子访问,并信任他们的提供者在电子访问期间给予他们的照顾。我们现在提出一项 第一类混合有效性--综合评估电子访问相对于TAU有效性的实施试验 同时评估在初级保健环境中交付时的实施情况。有效性 结果将通过6个月的随访进行评估,包括:1)循证戒烟治疗 2)每天减少吸烟,以及3)经过生化验证的7天点戒烟盛行率。 实施结果将在患者、提供者和组织层面进行评估。这是一项 研究有可能给吸烟者带来广泛和直接的好处:1)吸烟者将有更多的治疗机会, 2)初级保健医生,他们可以更有效地治疗吸烟者,同时还可以获得额外的有偿服务;以及3) 护理系统,世卫组织可以改善联合委员会戒烟治疗建议的遵从性。

项目成果

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Jennifer Renee Dahne其他文献

Jennifer Renee Dahne的其他文献

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{{ truncateString('Jennifer Renee Dahne', 18)}}的其他基金

Hybrid Type 1 Effectiveness-Implementation Trial of a Proactive Smoking Cessation Electronic Visit for Scalable Delivery via Primary Care
主动戒烟电子就诊的混合 1 型有效性实施试验,通过初级保健进行可扩展交付
  • 批准号:
    10365698
  • 财政年份:
    2022
  • 资助金额:
    $ 57.65万
  • 项目类别:
Addressing Rural Cancer Disparities via Proactive Smoking Cessation Treatment within Primary Care: A Hybrid Type 1 Effectiveness-Implementation Trial of a Scalable Smoking Cessation Electronic Visit
通过初级保健中的主动戒烟治疗解决农村癌症差异:可扩展戒烟电子就诊的 1 型混合有效性实施试验
  • 批准号:
    10701074
  • 财政年份:
    2022
  • 资助金额:
    $ 57.65万
  • 项目类别:
Addressing Rural Cancer Disparities via Proactive Smoking Cessation Treatment within Primary Care: A Hybrid Type 1 Effectiveness-Implementation Trial of a Scalable Smoking Cessation Electronic Visit
通过初级保健中的主动戒烟治疗解决农村癌症差异:可扩展戒烟电子就诊的 1 型混合有效性实施试验
  • 批准号:
    10552185
  • 财政年份:
    2022
  • 资助金额:
    $ 57.65万
  • 项目类别:
Development and Evaluation of a Brief Behavioral Activation Mobile Application for Nicotine Vaping Cessation Among Adolescent Primary Care Patients
针对青少年初级保健患者戒烟尼古丁的简短行为激活移动应用程序的开发和评估
  • 批准号:
    10250714
  • 财政年份:
    2021
  • 资助金额:
    $ 57.65万
  • 项目类别:
Remote Methods to Biochemically Verify Smoking Status
生化验证吸烟状况的远程方法
  • 批准号:
    9884111
  • 财政年份:
    2020
  • 资助金额:
    $ 57.65万
  • 项目类别:
Development and Testing of a Depression-Specific Behavioral Activation Mobile App Paired with Nicotine Replacement Therapy Sampling for Smoking Cessation Treatment Via Primary Care
开发和测试抑郁症特异性行为激活移动应用程序,并结合尼古丁替代疗法采样,通过初级保健进行戒烟治疗
  • 批准号:
    10364683
  • 财政年份:
    2018
  • 资助金额:
    $ 57.65万
  • 项目类别:
Development and Testing of a Depression-Specific Behavioral Activation Mobile App Paired with Nicotine Replacement Therapy Sampling for Smoking Cessation Treatment Via Primary Care
开发和测试抑郁症特异性行为激活移动应用程序,并结合尼古丁替代疗法采样,通过初级保健进行戒烟治疗
  • 批准号:
    10112873
  • 财政年份:
    2018
  • 资助金额:
    $ 57.65万
  • 项目类别:
Development and testing of a behavioral activation mobile therapy for elevated depressive symptoms
针对抑郁症状加重的行为激活移动疗法的开发和测试
  • 批准号:
    10341195
  • 财政年份:
    2015
  • 资助金额:
    $ 57.65万
  • 项目类别:
Development and testing of a behavioral activation mobile therapy for elevated depressive symptoms
针对抑郁症状加重的行为激活移动疗法的开发和测试
  • 批准号:
    10006356
  • 财政年份:
    2015
  • 资助金额:
    $ 57.65万
  • 项目类别:
Development and testing of a behavioral activation mobile therapy for elevated depressive symptoms
针对抑郁症状加重的行为激活移动疗法的开发和测试
  • 批准号:
    10116480
  • 财政年份:
    2015
  • 资助金额:
    $ 57.65万
  • 项目类别:

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  • 批准号:
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