Fax to Quit: Linking Smokers Visiting Clinics to State Quitlines

描述（由申请人提供）：在今天的美国，尽管有有效的干预措施，但烟草使用作为一种独特的致命性、普遍性和被忽视的状况脱颖而出。这种令人不安的情况突出表明，需要传播有效的干预措施，以便有意地减少烟草使用的流行。在现有的循证治疗方案中，电话戒烟热线可能提供了最大的未实现的承诺，帮助很大一部分美国吸烟者成功戒烟。电话戒烟热线是治疗烟草依赖的有效方法。由于强有力的经验支持，所有50个州现在都提供全州范围的戒烟热线服务。然而，戒烟热线的覆盖范围或人口外显率一直很低（每年占吸烟者的1-3%），而促进戒烟热线使用的传统手段——与戒烟热线使用有关的付费媒体宣传和药物赠品——对于正在努力减少烟草控制资金的州来说，往往过于昂贵。“传真戒烟”是一项将州戒烟热线与每年去看初级保健医生的70%的吸烟者联系起来的策略，已被确定为以潜在的较低成本增加戒烟热线覆盖面的一种手段。在操作上，每一位到初级保健机构就诊的烟草使用者都会被问及是否有兴趣戒烟，并接受戒烟热线咨询。如果他/她同意，将转诊传真（或电子传输）到州戒烟热线，然后该热线主动联系烟草使用者。这一战略的潜力已经导致40多个州实施了某种形式的“传真戒烟”。然而，这种有希望的方法还没有得到充分的评估，一些证据表明，传真戒烟的转诊率和连接率往往很低。本提案旨在系统地评估两种形式的传真到辞职：传真到辞职单独（FQ）和传真到辞职加强化学术细节（FQ + EAD），其中EAD包括持续的培训/技术援助和绩效反馈。在收集戒烟线转诊的基线率后，40家诊所将被随机分配接受FQ或FQ + EAD。将测量诊所转诊率、戒烟热线患者接触和“质量接触”（当转诊导致个人参加戒烟热线咨询服务时）。此外，定性研究部分将评估两种干预措施的关键方面，经济分析将比较两种“传真戒烟”干预措施的成本与媒体和其他当前戒烟线上宣传策略的成本。该提案的目的是为了满足这一区域资源协定的研究目标；开展转化研究，采用循证干预措施，有可能促进促进健康和预防疾病的2010年健康人目标。

DESCRIPTION (provided by applicant): In America today, tobacco use stands out as a condition of unique lethality, prevalence, and neglect, despite the availability of effective interventions. This troubling set of circumstances highlights the need to disseminate effective interventions so as to meaningfully reduce tobacco use prevalence. Among available evidence-based treatment options, telephone quitlines may offer the greatest unrealized promise to help a large proportion of U.S. smokers to successfully quit. Telephone quitlines are effective treatments for tobacco dependence. As a result of strong empirical support, all 50 states now provide statewide quitline services. Yet the reach, or population penetrance, of quitlines has been low (1-3% of smokers annually) and traditional means of boosting quitline use - paid media campaigns and medication give-aways linked to quitline use - are often prohibitively expensive for states struggling with declining tobacco control funding. Fax to Quit - a strategy to link state quitlines to the 70% of smokers who visit a primary care physician each year - has been identified as a means of increasing quitline reach at potentially lower cost. Operationally, every tobacco user making a primary care visit is asked if s/he is interested in quitting and receiving quitline counseling. If s/he agrees, a referral is faxed (or transmitted electronically) to the state quitline, which then proactively contacts the tobacco user. The potential of this strategy has led more than 40 states to implement some form of Fax to Quit. Yet, this promising approach has not been adequately evaluated and some evidence indicates that Fax to Quit referral and connection rates are often low. This proposal is designed to systematically evaluate two forms of Fax to Quit: Fax to Quit alone (FQ) and Fax to Quit plus Enhanced Academic Detailing (FQ + EAD) with EAD comprising ongoing training/technical assistance and performance feedback. After collecting baseline rates of quitline referrals, 40 clinics will be randomized to receive either FQ or FQ + EAD. Clinic referral rates, quitline-patient contacts, and "quality contacts" (when referrals result in the individual enrolling in quitline counseling services) will be measured. In addition, a qualitative research component will evaluate key aspects of the two interventions and an economic analysis will compare the cost of the two Fax to Quit interventions to the costs of media and other current quitline promotional strategies. The proposal is designed to meet the research objectives of this RFA; to conduct translational research using an evidence-based intervention that has the potential to foster the Healthy People 2010 goals of enhanced health promotion and disease prevention.