Telemedicine for Smoking Cessation in Rural Primary Care

农村初级保健中戒烟的远程医疗

• 批准号: 7526523
• 负责人: KIMBER P RICHTER
• 金额: $ 74.67万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7526523
• 关键词: Abstinence; Accounting; Address; Adherence; Adoption; American; Americas; Behavioral; Caring; Cessation Research; Cigarette; Cigarette Smoker; Clinic; Clinical; Collaborations; Communities; Competence; Computer software; Computers; Condition; Cost Effectiveness Analysis; Costs and Benefits; Counseling; Development; Diabetes Mellitus; Disease Management; Economics; Effectiveness; Enrollment; Ensure; Equation; Freezing; Funding; Future; Goals; Health; Health Services Research; Home environment; Internet; Intervention; Kansas; Mediation; Medical Care Team; Medical Records; Medical Students; Medical center; Medicare; Methods; Modeling; Monitor; Morbidity - disease rate; Motivation; Obesity; Outcome; Outcome Measure; Paper; Participant; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Physicians' Offices; Population Heterogeneity; Prevalence; Primary Health Care; Printing; Professional counselor; Protocols documentation; Provider; Psychiatric therapeutic procedure; Public Health; Randomized; Rate; Recruitment Activity; Relative (related person); Reporting; Research; Research Personnel; Resources; Rural; Rural Population; Self Determination; Services; Smoke; Smoker; Smoking Cessation Intervention; Speed; Standards of Weights and Measures; Structure; Supervision; Telemedicine; Telephone; Testing; Time; Tobacco; Universities; Upper arm; Work; addiction; base; cigarette smoking; cost; cost effective; cost effectiveness; day; effectiveness research; experience; health care quality; medically underserved; mortality; novel strategies; prescription document; prescription procedure; programs; provider intervention; quitline; rural area; smoking cessation; smoking prevalence; theories; therapy design; treatment effect

DESCRIPTION (provided by applicant): In rural America cigarette smoking is prevalent, few cessation services are available, and physicians often lack the time or resources to help smokers quit. This project examines whether telemedicine counseling that is integrated into rural physician practices can outperform standard quitline counseling for smoking cessation. This is the second and final revision of this application. The study is conducted through 25 rural physician practices in Kansas. Medical students on rural preceptorships will recruit patients who are smokers into the trial. Self-Determination Theory guides the structure of study components and the analytic plan. Patients will be randomly assigned to receive a standard telephone quit line intervention (QL) or an integrated telemedicine intervention (ITM). Patients in QL will receive 4 sessions of quitline counseling delivered by telephone in their homes. Patients in ITM will receive 4 sessions of telemedicine counseling delivered by 2-way webcams mounted on desktop computers in their physician office examining room. Webcams are paired with powerful software, Polycom PVX, that permits document sharing and other activities for a highly interactive counseling experience free of the "freeze-ups" and audio delays common with standard webcams. QL and ITM counseling will be delivered by professional smoking cessation counselors from the University of Kansas Medical Center Campus. The counseling protocol involves an autonomy-supportive approach. Fidelity monitoring will ensure the content remains the same across both study arms. Both groups will receive paper-copy Quit Tips and individually-tailored quit plans and pharmacotherapy guidance. However, all aspects of ITM will be integrated into primary care practice: sessions will take place in the physician's office; study materials will be completed and printed for ITM patients during each counseling session via the telemedicine computer printer, and copies of session materials will be printed for insertion into the patients' medical record. We hypothesize that ITM will outperform QL by enhancing perceived support from the counselor through the video interface, and by facilitating more autonomy support from the patients' health care team, including support for quitting, support for using medications to quit, and access to pharmacotherapy prescriptions. We project that 566 patients, 283 in each study arm, are necessary to detect differences between abstinence rates in QL and ITM at 12-months post enrollment. We hypothesize that ITM will be more costly, but also more cost- effective, than QL. Counseling fidelity monitoring and strong clinic support will ensure optimal implementation. The investigative team has expertise in smoking cessation research, telemedicine, clinical cost- effectiveness research, and quality improvement in primary care. The intervention is delivered in collaboration with one of the oldest and most successful telemedicine programs in the U.S. This intervention provides a venue for reaching a large population of rural smokers who have poor access to smoking cessation services. It has strong potential for widespread adoption, and future adaptation for other pressing issues such as obesity. Public Health Relevance: Cigarette smoking is prevalent in rural areas, and physicians often lack the time and resources to help smokers quit. This project examines whether telemedicine counseling that is delivered through physician offices is effective for smoking cessation among rural smokers. The potential health impact is large because the prevalence of smoking is high in rural areas, access to smoking cessation services is low, and new rules for Medicare reimbursement creates a strong potential for widespread adoption.

描述（由申请人提供）：在美国农村，吸烟很普遍，很少有戒烟服务，医生往往缺乏时间或资源来帮助吸烟者戒烟。本项目研究远程医疗咨询是否被纳入农村医生的做法可以优于标准戒烟咨询。这是本申请的第二次也是最后一次修订。这项研究是通过在堪萨斯的25个农村医生的做法。在农村接受培训的医学生将招募吸烟者参加试验。自我决定理论指导着学习内容的结构和分析计划。患者将被随机分配接受标准电话戒烟热线干预（QL）或综合远程医疗干预（ITM）。QL的患者将在家中接受4次电话戒烟咨询。ITM的患者将接受4次远程医疗咨询，这些咨询是通过安装在医生办公室检查室台式电脑上的双向网络摄像头提供的。网络摄像头与功能强大的软件Polycom PVX搭配使用，可以进行文档共享和其他活动，从而获得高度互动的咨询体验，而不会出现标准网络摄像头常见的“冻结”和音频延迟。QL和ITM咨询将由来自堪萨斯医学中心校区的专业戒烟顾问提供。咨询方案包括一种支持性的方法。保真度监测将确保两个研究组的内容保持相同。两组都将收到纸质戒烟提示和个性化的戒烟计划和药物治疗指导。然而，ITM的所有方面将被整合到初级保健实践中：会议将在医生的办公室进行;研究材料将在每次咨询会议期间通过远程医疗计算机打印机为ITM患者完成和打印，并打印会议材料的副本以插入患者的医疗记录。我们假设，ITM将通过视频界面增强从顾问感知的支持，并通过促进更多的自主性支持，从患者的医疗保健团队，包括支持戒烟，支持使用药物戒烟，并获得药物治疗处方，从而超越QL。我们计划566例患者，每个研究组283例，需要检测入组后12个月QL和ITM的戒烟率之间的差异。我们假设ITM将比QL更昂贵，但也更具有成本效益.咨询忠诚度监测和强大的诊所支持将确保最佳实施。调查小组在戒烟研究、远程医疗、临床成本效益研究和初级保健质量改善方面拥有专长。该干预措施是与美国最古老和最成功的远程医疗计划之一合作提供的，该干预措施为接触大量难以获得戒烟服务的农村吸烟者提供了场所。它具有广泛采用的强大潜力，并在未来适应肥胖等其他紧迫问题。公共卫生相关性：吸烟在农村地区很普遍，医生往往缺乏时间和资源来帮助吸烟者戒烟。该项目研究通过医生办公室提供的远程医疗咨询是否对农村吸烟者戒烟有效。潜在的健康影响很大，因为农村地区吸烟率很高，获得戒烟服务的机会很低，医疗保险报销的新规则创造了广泛采用的强大潜力。