Telemedicine for Smoking Cessation in Rural Primary Care

农村初级保健中戒烟的远程医疗

基本信息

批准号：
7901648
负责人：
KIMBER P RICHTER
金额：
$ 71.95万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-15 至 2012-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7901648
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 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 Persons Pharmaceutical Preparations Pharmacotherapy Physicians Physicians&apos Offices Population Heterogeneity Prevalence Primary Health Care Printing Professional counselor Protocols documentation Provider Psychiatric therapeutic procedure Public Health Randomized Recruitment Activity Relative (related person)Reporting Research Research Personnel Resources Rural Rural Population Self Determination Services Smoke Smoker Smoking Cessation Intervention Speed Structure Supervision Telemedicine Telephone Testing Time Tobacco Universities Work addiction arm base cigarette smoking control trial cost cost effective cost effectiveness effectiveness research experience health care quality medically underserved mortality novel strategies programs provider intervention public health relevance quitline rural area smoking cessation smoking prevalence suburb theories therapy design treatment effect

项目摘要

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，医生通常缺乏帮助吸烟者戒烟的时间或资源。该项目研究了将远程医疗咨询纳入农村医师实践是否可以优于戒烟的标准戒烟咨询。这是此应用程序的第二个也是最后一次修订。这项研究是通过堪萨斯州的25种农村医师实践进行的。从事农村教育的医学生将招募吸烟者参加试验。自决理论指导研究组件的结构和分析计划。将随机分配患者接受标准的电话退出管线干预（QL）或综合远程医疗干预（ITM）。 QL中的患者将在他们家中通过电话提供4次戒烟咨询。 ITM中的患者将接受4次会议的远程医疗咨询，该链球菌咨询由安装在其医师办公室检查室台式计算机上的2条网络摄像头提供。网络摄像头与功能强大的软件Polycom PVX配对，该软件允许提供文档共享和其他活动，以获得高度交互式咨询体验，可以免费获得“冻结”，并且音频延迟了标准网络摄像头。 QL和ITM咨询将由堪萨斯大学医学中心校园的专业戒烟辅导员提供。咨询协议涉及一种自主支持的方法。保真度监视将确保在两个研究臂上保持内容相同。这两组将收到纸质拷贝退出的提示，并进行了单独限制的戒烟计划和药物治疗指导。但是，ITM的所有方面都将纳入初级保健实践：会议将在医师的办公室举行；研究材料将通过远程医疗计算机打印机在每次咨询期间为ITM患者完成并印刷，并将打印会话材料的副本，以插入患者的病历中。我们假设ITM通过通过视频界面增强辅导员的感知支持，并促进患者医疗团队的更多自治支持，包括退出戒烟，使用药物退出的支持以及使用药物治疗处方，从而胜过QL的表现。我们预测，在入学后12个月时，有566名患者在每个研究部门中有283例，以检测QL中的禁欲和ITM的戒酒率之间的差异。我们假设ITM比QL更为昂贵，但更具成本效益。咨询保真度监测和强大的诊所支持将确保最佳实施。调查团队在戒烟研究，远程医疗，临床成本效益研究和初级保健质量改善方面具有专业知识。该干预措施与美国最古老，最成功的远程医疗计划之一合作进行，该干预措施为吸烟服务提供不良的农村吸烟者提供了一个场所。它具有广泛采用的强大潜力，以及对肥胖等其他紧迫问题的未来适应。公共卫生相关性：吸烟在农村地区很普遍，医生通常缺乏帮助吸烟者戒烟的时间和资源。该项目研究了通过医师办公室提供的远程医疗咨询是否对农村吸烟者的戒烟有效。潜在的健康影响很大，因为农村地区吸烟的流行率很高，吸烟戒烟服务的机会很低，而医疗保险报销的新规定为广泛采用而产生了强大的潜力。