Implementing Tobacco Control in Dental Practice

在牙科实践中实施烟草控制

• 批准号: 6803637
• 负责人: JACK F HOLLIS
• 金额: $ 44.16万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-26 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6803637
• 关键词: adult human (21+); clinical research; clinical trials; cost effectiveness; counseling; human subject; longitudinal human study; managed care; oral health; questionnaires; smoking cessation; tobacco abuse prevention

DESCRIPTION (provided by applicant): In this HMO system-level randomized controlled effectiveness trial, we will evaluate the feasibility, effectiveness, cost-effectiveness, and sustainability of an innovative and practical team approach for delivering smoking cessation assistance to interested smokers in a large dental HMO. We, and others, have demonstrated the efficacy of the 5A model in medical and dental settings. Progress has been made nationally in implementing and maintaining the Ask and Advise components of the 5A model in routine practice, but less progress has been made with the Assist and Arrange components, particularly in dental practice. Barriers to implementation are significant. More practical and innovative approaches are needed that minimize demands on staff, yet take advantage of the "teachable moment" created by the clinical encounter to encourage more patients to access and use convenient cessation support services. Chart reviews show that KP dentists and hygienists currently provide simple advice to almost all smokers, but do not provide cessation assistance. In this study, dentists and hygienists in half of 14 large facilities will be trained to connect tobacco users by phone to a professionally staffed tobacco quitline as a part of the dental visit. If patients prefer, quitline staff will call them at a more convenient time. Quitline staff will provide brief counseling and assessment and a full menu of cessation services, including multi-session telephone and face-to-face programs and medications. This Active Referral strategy is both practical and innovative, as it takes advantage of available resources; efficiently distributes intervention activities between dentists, hygienists, and counseling specialists; and could be delivered in individual, small, or large dental practices. Service delivery and one-year cessation outcomes will be assessed for randomly selected treatment and control patients (n--2,800) with dental exam visits either early or later in the implementation period. The large size of the KP dental plan (160,000 members) makes it feasible to evaluate the proposed approach. The findings will be generalizable because the practice style and visit flow for staff is similar to other practice settings, and telephone-based quitline services are widely available through state-run quitlines.

描述（由申请人提供）：在这项 HMO 系统级随机对照有效性试验中，我们将评估在大型牙科 HMO 中向感兴趣的吸烟者提供戒烟援助的创新实用团队方法的可行性、有效性、成本效益和可持续性。我们和其他人已经证明了 5A 模型在医疗和牙科环境中的功效。全国范围内，在日常实践中实施和维护 5A 模型的“询问”和“建议”部分方面取得了进展，但在“协助”和“安排”部分方面取得的进展较少，特别是在牙科实践中。实施障碍很大。需要更实用和创新的方法，最大限度地减少对工作人员的要求，同时利用临床经验创造的“教学时刻”，鼓励更多患者获得和使用方便的戒烟支持服务。图表审查显示，KP 牙医和卫生员目前向几乎所有吸烟者提供简单的建议，但不提供戒烟援助。在这项研究中，14 个大型机构中一半的牙医和卫生员将接受培训，作为看牙医的一部分，通过电话将烟草使用者连接到配备专业人员的戒烟热线。如果患者愿意，戒烟热线工作人员会在更方便的时间给他们打电话。戒烟热线工作人员将提供简短的咨询和评估以及全套戒烟服务，包括多会话电话和面对面的计划和药物。这种主动推荐策略既实用又创新，因为它利用了可用资源；在牙医、卫生员和咨询专家之间有效分配干预活动；并且可以在个体、小型或大型牙科诊所中提供。将评估随机选择的治疗患者和对照患者 (n--2,800) 的服务提供和一年戒烟结果，这些患者在实施期间的早期或后期进行了牙科检查。 KP 牙科计划的规模较大（160,000 名会员），使得评估所提议的方法变得可行。研究结果具有普遍性，因为工作人员的执业方式和就诊流程与其他执业环境相似，并且通过国营戒烟热线广泛提供基于电话的戒烟热线服务。