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：治疗烟草使用和依赖》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，可显著提高戒烟率。不幸的是，提供者对指南建议的依从性很差。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实践环境中，指南执行不力，导致吸烟率和烟草相关疾病的差距越来越大。本建议通过审查在牙科公共卫生诊所实施以证据为基础的治疗烟草依赖指南的三种实用和高度可复制战略的有效性，解决了这一从研究到实践的差距。牙科服务提供者在提供戒烟服务方面具有可靠的核心作用。大多数吸烟者每年看一次牙医，吸烟是口腔疾病的一个已知风险因素。此外，对照试验已经证明了以牙科诊所为基础的戒烟干预的有效性和有效性。然而，牙科保健机构仍然是治疗烟草依赖的一个相对未开发的场所。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。我们提出了一项三组随机对照试验，该试验将1)比较实施PHS烟草使用治疗指南的三种有前景的策略的有效性和成本：a)员工培训和当前最佳实践（CBP）；2) CBP +提供者绩效反馈（PF）和3)CBP + PF +提供者对提供者遵守烟草使用治疗建议指南的戒烟治疗的报销（绩效报酬）；2)使用混合方法研究组织和提供者层面潜在的理论驱动机制，以解释三种实施策略的比较有效性；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。试验将在18间公立牙科诊所进行

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.