Implementing tobacco use treatment guidelines in dental public health clinics

描述（由申请人提供）：吸烟仍然是美国发病率和死亡率的主要原因。2008年公共卫生服务指南《烟草使用和依赖治疗》提供了强有力的证据，表明简短的建议与咨询和药物治疗等援助相结合，可以显著提高戒烟率。不幸的是，提供商对指南建议的遵守程度很差。在实践环境中，特别是在为少数民族和其他弱势群体服务的环境中，《准则》执行不力，导致吸烟流行率和烟草相关疾病方面的差距越来越大。该提案通过检查三种实用且高度可复制的策略在牙科公共卫生诊所实施烟草依赖治疗循证指南的有效性来解决研究与实践之间的差距。牙科服务提供者在提供戒烟服务方面发挥着可靠和核心的作用。大多数吸烟者每年都去看牙医，烟草使用是口腔疾病的已知风险因素。此外，对照试验已经证明了基于牙科诊所的戒烟干预措施的功效和有效性。然而，牙科保健机构仍然是一个相对未开发的场所，用于治疗烟草依赖。为了将循证戒烟治疗纳入常规牙科实践，必须确定最佳实施流程和策略。我们提出了一个3臂，集群随机对照试验，将1）比较有效性和成本的三个有前途的战略实施的PHS烟草使用治疗指南：a）工作人员培训和目前的最佳做法（CBP）; 2）CBP +提供者绩效反馈（PF）和3）CBP + PF +提供者提供戒烟治疗的报销（按绩效付费）对提供者遵守烟草使用治疗建议指南的影响; 2）使用混合方法的方法来检查组织和提供者层面上的潜在理论驱动机制，假设这些机制可以解释三种实施策略的相对有效性;以及3）确定影响牙科诊所实施循证烟草使用治疗实践的基线组织因素。试验计划将在18间公营牙科诊所进行 有关实施结果和过程的信息将来自多个数据源（患者离职面谈、提供者调查和半结构化面谈）。在强调提供者信念和组织特征的概念框架的指导下，我们将确定影响牙科诊所实施过程的因素。拟议研究的最终目标是提供关键的新知识，以促进在美国牙科实践中广泛采用、实施、传播和持续利用循证烟草使用治疗策略。 公共卫生相关性：尽管存在支持戒烟的有效治疗方法，但吸烟仍然是美国发病率和死亡率的主要原因。牙科公共卫生诊所提供了一个独特的和相对未开发的机会，以帮助那些最需要戒烟服务的病人。这项研究将测试护理模式，这些模式有望增加戒烟临床实践指南在常规牙科实践中的采用和实施，这是实现国家健康目标和最终减少美国烟草相关健康差异的重要一步。

DESCRIPTION (provided by applicant): Smoking remains the leading cause of morbidity and mortality in the United States. The 2008 Public Health Service Guideline (PHS), Treating Tobacco Use and Dependence provides strong evidence that brief advice combined with assistance such as counseling and pharmacotherapy, can significantly increase quit rates. Unfortunately, provider adherence to Guideline recommendations is poor. Inadequate implementation of the Guideline in practice settings, particularly those serving ethnic minorities and other vulnerable populations, has contributed to growing disparities in smoking prevalence and tobacco-related illness. This proposal addresses this research-to-practice gap by examining the effectiveness of three practical and highly replicable strategies for implementing evidence-based guidelines for the treatment of tobacco dependence in dental public health clinics. Dental providers have a credible and central role in providing tobacco cessation services. The majority of smokers see a dentist annually and tobacco use is a known risk factor for oral disease. Moreover, controlled trials have demonstrated the efficacy and effectiveness of dental office-based cessation interventions. Yet dental care settings remain a relatively untapped venue for the treatment of tobacco dependence. In order to integrate evidence-based tobacco cessation treatment into routine dental practice, optimal implementation processes and strategies must be identified. We propose a 3-arm, cluster randomized controlled trial that will 1) Compare the effectiveness and cost of three promising strategies for implementation of the PHS tobacco use treatment guidelines: a) Staff training and current best practices (CBP); 2) CBP + provider performance feedback (PF) and 3) CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay for performance) on provider adherence to recommended guidelines for tobacco use treatment; 2) Use a mixed-methods approach to examine potential theory-driven mechanisms at the organizational and provider level hypothesized to explain the comparative effectiveness of three strategies for implementation; and 3) Identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The trial will be conducted in 18 public dental care clinics and information about implementation outcomes and processes will be derived from multiple data sources (patient exit interviews, provider surveys and semi- structured interviews). Guided by a conceptual framework that emphasizes provider beliefs and organizational characteristics, we will identify factors that influence the implementation process in dental clinics. The ultimate goal of the proposed research is to provide critical new knowledge to facilitate the widespread adoption, implementation, dissemination and sustained utilization of evidence-based tobacco use treatment strategies in dental practices across the U.S. PUBLIC HEALTH RELEVANCE: Project Narrative Despite the existence of effective treatments to support smoking cessation, cigarette smoking remains the leading cause of morbidity and mortality in the United States. Dental public health clinics afford a unique and relatively untapped opportunity to help those patients most in need of smoking cessation services. This study will test models of care that have promise to increase adoption and implementation of tobacco cessation clinical practice guideline into routine dental practice, an essential step toward achieving national health objectives and for ultimately reducing tobacco-related health disparities in the United States.