Disease Management for Smokers in Rural Primary Care

农村初级保健中吸烟者的疾病管理

• 批准号: 6915619
• 负责人: Edward F. Ellerbeck
• 金额: $ 65.03万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-07-09 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6915619
• 关键词: behavior therapy; behavioral /social science research tag; bupropion; clinical research; counseling; disease /disorder prevention /control; drug abuse chemotherapy; human subject; human therapy evaluation; longitudinal human study; motivation; nicotine; nicotine replacement; patient oriented research; primary care physician; rural area; smoking; smoking cessation; therapy compliance; tobacco abuse; tobacco abuse education; transdermal drug delivery

DESCRIPTION (provided by applicant): Cigarette smoking and complications from cigarette smoking disproportionately affect people living in rural communities. Previous strategies to promote smoking cessation have largely been urban-based, involved short term interventions, enrolled smokers already motivated to quit, and been poorly integrated into primary care practice. Nicotine addiction may be better conceptualized as a chronic illness that might be most effectively addressed using newer models of chronic disease management. A disease management approach to smoking cessation would provide support for multiple quit attempts, treat smokers of all stages of readiness to quit, and coordinate cessation efforts with primary health care providers. The primary aim of this study is to assess the effectiveness of both high and low intensity, disease management programs for nicotine dependence. In this study, we will recruit 750 smokers from 20 rural, primary care clinics in Kansas. Subjects will be randomly assigned to one of three study arms, each providing 20 months of treatment: C (comparison group), LDM (low-intensity disease management) or HDM (high-intensity disease management). Participant's in-group C will receive health educational mailings and an offer for free nicotine replacement therapy (six weeks) or bupropion (seven weeks) every 6 months (months 0, 6, 12, and 18). Participants in LDM will receive the same interventions as C plus a low-intensity disease management program that includes a single telephone counseling session using motivational interviewing (MI)at months 0, 6, 12, and 18 to encourage a cessation attempt and also includes coordination of smoking assessments and pharmacotherapy with the patient's physician. HDM participants will receive C plus a high intensity disease management program that includes up to six telephone-based MI counseling sessions at months 0, 6, 12, and 18 to encourage a smoking cessation attempt and to prevent relapse after a quit attempt, as well as coordination of smoking assessments, quit attempts, and pharmacotherapy with the patient's physician. The primary outcome of the study is 7-day point prevalence abstinence from cigarettes at 2 years after enrollment. Secondary outcomes include: 1) number of quit attempts and 2) progress in stage of change. If successful, this intervention will provide a generalizable model for addressing nicotine dependence that could improve long-term management of smoking in primary care.

描述（由申请人提供）：吸烟和吸烟并发症不成比例地影响生活在农村社区的人。以前的促进戒烟的策略主要是基于城市的，涉及短期干预，登记的吸烟者已经有戒烟的动机，并且没有很好地融入初级保健实践。尼古丁成瘾可能更好地被概念化为一种慢性疾病，使用新的慢性疾病管理模式可能最有效地解决。戒烟的疾病管理方法将为多次戒烟尝试提供支持，治疗准备戒烟的所有阶段的吸烟者，并与初级卫生保健提供者协调戒烟工作。本研究的主要目的是评估高强度和低强度疾病管理计划对尼古丁依赖的有效性。在这项研究中，我们将从堪萨斯的20个农村初级保健诊所招募750名吸烟者。受试者将被随机分配到三个研究组之一，每个研究组提供20个月的治疗：C（对照组），LDM（低强度疾病管理）或HDM（高强度疾病管理）。参与者的C组将每6个月（第0、6、12和18个月）收到健康教育邮件和免费尼古丁替代疗法（6周）或安非他酮（7周）。LDM的参与者将接受与C相同的干预措施，加上低强度疾病管理计划，包括在第0、6、12和18个月使用动机性访谈（MI）进行单一电话咨询，以鼓励戒烟尝试，还包括与患者医生协调吸烟评估和药物治疗。HDM参与者将接受C+高强度疾病管理计划，包括在第0、6、12和18个月进行多达6次基于电话的MI咨询会议，以鼓励戒烟尝试并预防戒烟尝试后复发，以及与患者医生协调吸烟评估、戒烟尝试和药物治疗。研究的主要结果是入组后2年的7天点戒烟率。次要结局包括：1）戒烟尝试次数和2）改变阶段的进展。如果成功，这种干预将为解决尼古丁依赖提供一个可推广的模型，可以改善初级保健中吸烟的长期管理。