Disease Management for Smokers in Rural Primary Care

描述(申请人提供)：吸烟和吸烟引起的并发症对居住在农村社区的人的影响不成比例。以前促进戒烟的战略大多以城市为基础，涉及短期干预，招募已有戒烟动机的吸烟者，并未将其纳入初级保健实践。尼古丁成瘾可能更好地被概念化为一种慢性病，使用新的慢性病管理模式可能会最有效地解决这一问题。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努力。这项研究的主要目的是评估高强度和低强度的疾病管理计划对尼古丁依赖的有效性。在这项研究中，我们将从堪萨斯州的20家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小组中的一个，每个小组提供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)。C组的参与者将每6个月(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)的优惠。LDM的参与者将接受与C相同的干预措施，外加一个低强度的疾病管理计划，其中包括在0、6、12和18个月使用动机访谈(MI)的单一电话咨询会议，以鼓励戒烟尝试，还包括与患者的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，其中包括在0、6、12和18个月最多6次基于电话的MI咨询会议，以鼓励戒烟尝试并防止戒烟尝试后复发，以及与患者的医生协调吸烟评估、戒烟尝试和药物治疗。这项研究的主要结果是在注册后2年的7天点戒烟流行率。次要结果包括：1)尝试戒烟的次数和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问题提供一个可推广的模式，可以改善初级保健中吸烟的长期管理。

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.