Connect to Quit: Coordinated Care for Smoking Cessation among Low Income Veterans

连接戒烟：低收入退伍军人戒烟的协调护理

• 批准号: 8396681
• 负责人: Hilary A. Tindle
• 金额: $ 6.15万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8396681
• 关键词: Abstinence; Address; Adult; Alcohol abuse; Alcohol or Other Drugs use; Annual Reports; Area; Attention; Behavior Therapy; Behavioral; Caring; Cessation of life; Chronic; Chronic Disease; Clinical Practice Guideline; Clinical Trials; Clinical Trials Design; Computerized Medical Record; Cost Measures; Data; Diabetes Mellitus; Direct Costs; Disease; Effectiveness; Effectiveness of Interventions; Enrollment; Evidence based intervention; Evidence based treatment; FDA approved; Face; Facilities and Administrative Costs; Feedback; Goals; Guidelines; Health; Healthcare; Healthcare Systems; Homelessness; Household; Hypertension; Income; Individual; Intention; Intervention; Justice; Knowledge; Low Income Population; Low income; Measures; Mediating; Medical; Military Personnel; National Formulary; Nicotine; Outpatients; Patients; Performance; Pharmaceutical Preparations; Pharmacotherapy; Plant Roots; Population; Positioning Attribute; Prevalence; Primary Health Care; Process; Process Measure; Provider; Questionnaires; Randomized; Readiness; Recycling; Relapse; Reporting; Research; Research Personnel; Resources; Risk; Services; Smoker; Smoking; Stable Populations; Staging; Substance abuse problem; Surveys; System; Techniques; Testing; Time; Tobacco; Tobacco Use Cessation; Tobacco use; United States; United States Department of Veterans Affairs; Veterans; Visit; base; brief intervention; care systems; chronic care model; cost; cost effectiveness; design; disorder later incidence prevention; evidence base; experience; improved; motivational enhancement therapy; novel; population based; programs; public health relevance; smoking cessation; smoking intervention; smoking prevalence; social; standard of care; therapy design; tobacco control; treatment as usual; treatment planning

DESCRIPTION (provided by applicant): Despite a reduction in smoking prevalence in the general United States adult population over the past 4 decades, the prevalence of smoking remains high among low income adults and low income veterans of the United States military. Despite the highly-advanced, population-based approach to tobacco control in the Veterans Administration (VHA) health care system, low income smokers remain difficult to treat. A pervasive, nationwide lack of approach to smoking as a chronic disease, with high relapse rates and multiple quit attempts per smoker even in the best of circumstances, is a critical deficit in the current standard of care for low income smokers, who are even less likely than wealthier individuals to quit smoking, and more likely to relapse when they do quit. The goal of this application is to examine the effectiveness of an intervention designed to reduce smoking in low income adults within a regional United States Veterans Administration (VHA) health care system. We propose a pro-active, personalized, coordinated system of care (Connect to Quit (CTQ)) which is rooted in the Chronic Care Model. CTQ treats smoking as a chronic condition that, like hypertension or diabetes, requires long term treatment with appropriate combinations of behavioral therapy and pharmacotherapy. CTQ will be evaluated in the context of 3 VA Pittsburgh Healthcare System (VAPHS) medical practices which care for ~2,400 low-income smokers, 93% of whom report an annual household income below $36,000 (27% make < $10K; 37% make from $10-$19,999K; 23% make from $20-$29,999K; and only 13% make > $30,000). Approximately 40 Primary Care Providers (PCPs, including non-physicians) in VAPHS (and their low income patients making < $36,000/year) will be invited to be randomized to either CTQ or Usual Care (UC, existing VHA services, without additional CTQ services). Desire to quit smoking is not required for participation in the study, as the point of CTQ is to engage smokers at every level of readiness to quit. Approximately 480 low income smokers in each group are expected to enroll and be followed for a minimum of 2 years. Investigators will measure abstinence (biochemically-validated 30 day point-prevalence) at the end of 2 years and over a 2-year period (measured every 6 months). Direct and indirect costs of care will be assessed to calculate the incremental cost per successful quit of CTQ vs. UC. Investigators will explore mediating effects of process measures related to treatment utilization and behavioral processes (of enrolled patients and providers) on the impact of CTQ. This proposal is led by Dr. Tindle, a new investigator, and represents a collaborative effort by investigators with complementary expertise, experience, and positioning to execute the study. The conservatively-estimated impact of CTQ to increase abstinence by ~5% above and beyond UC (representing a 50-100% increase in cessation) at two years would result in ~50,000 fewer low income smokers in the national VA population of low income veterans, and ~300,000 fewer if projected nationally to all low-income smokers. PUBLIC HEALTH RELEVANCE: Smoking is the leading preventable cause of disease and death in the United States and in the world, yet smoking remains common among people with low income, such as low income veterans of the United States military. This project will test how well a program called "Connect to Quit" helps low income veterans quit smoking. The program treats smoking as an ongoing health condition that, like high blood pressure or diabetes, needs a combination of ongoing support, classes, and medication. The results of this project will improve our understanding of how to help low income veterans successfully quit smoking.

描述（由申请人提供）：尽管在过去40年中，美国成年人人口的吸烟率降低了，但在美国军方的低收入成年人和低收入的退伍军人中，吸烟率仍然很高。尽管在退伍军人管理局（VHA）医疗保健系统中采取了高度研究，基于人群的烟草控制方法，但低收入吸烟者仍然难以治疗。在全国范围内，全国范围内缺乏吸烟的方法，即使在最好的情况下，每名吸烟率高，每次吸烟者的戒烟尝试较高，这是当前低收入吸烟者的护理标准的严重赤字，而低收入吸烟者的可能性比富人戒烟的可能性更低，并且在他们戒烟时可能更可能复发。该应用的目的是检查旨在减少美国退伍军人管理局（VHA）医疗保健系统中低收入成年人吸烟的干预措施的有效性。 我们提出了一个植根于慢性护理模型的积极主动，个性化的护理系统（连接到QUIT（CTQ））。 CTQ将吸烟视为一种慢性疾病，例如高血压或糖尿病，需要长期治疗，以适当的行为疗法和药物治疗组合。 CTQ will be evaluated in the context of 3 VA Pittsburgh Healthcare System (VAPHS) medical practices which care for ~2,400 low-income smokers, 93% of whom report an annual household income below $36,000 (27% make < $10K; 37% make from $10-$19,999K; 23% make from $20-$29,999K; and only 13% make > $30,000).大约有40名初级保健提供者（包括PCP，包括非医师）在VAPAS中（及其低收入患者少于36,000美元/年），邀请将其随机分配给CTQ或常规护理（UC，现有的VHA服务，而无需其他CTQ服务）。参与研究并不需要戒烟的愿望，因为CTQ的目的是让吸烟者以各种准备就绪戒烟。每组中约有480名低收入吸烟者预计将注册，并至少持续2年。研究人员将在2年结束时测量戒酒（生物化学验证的30天点差异），并在2年的时间内（每6个月测量一次）。将评估直接和间接护理费用，以计算CTQ与UC的成功戒烟的增量成本。研究人员将探讨与治疗利用和行为过程（招募的患者和提供者）对CTQ影响有关的过程度量的中介作用。 该建议由新调查员廷德尔（Tindle）博士领导，并代表了具有互补专业知识，经验和执行研究的调查人员的合作努力。 CTQ在两年内将戒酒的保守影响增加了约5％（停止增加50-100％），将导致约50,000名低收入退伍军人人口的低收入吸烟者减少约50,000，而如果全国范围内投影到所有低收入吸烟者，则少于300,000个。 公共卫生相关性：吸烟是美国和世界上可预防的疾病和死亡的主要原因，但是在低收入人群中，吸烟仍然很普遍，例如美国军队的低收入退伍军人。该项目将测试一个名为“戒烟”的程序如何帮助低收入退伍军人戒烟。该计划将吸烟视为一种持续的健康状况，例如高血压或糖尿病，需要持续的支持，课程和药物治疗。该项目的结果将提高我们对如何帮助低收入退伍军人成功戒烟的理解。