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: 8463472
• 负责人: Hilary A. Tindle
• 金额: $ 53.12万
• 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/8463472
• 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.

描述（由申请人提供）：尽管过去 4 年来美国成年人口的吸烟率有所下降，但低收入成年人和美国军队低收入退伍军人的吸烟率仍然很高。尽管退伍军人管理局 (VHA) 医疗保健系统采用了非常先进、基于人群的烟草控制方法，但低收入吸烟者仍然难以治疗。全国范围内普遍缺乏将吸烟视为一种慢性疾病的方法，即使在最好的情况下，吸烟者的复吸率也很高，而且每个吸烟者都会多次尝试戒烟，这是当前低收入吸烟者护理标准的一个严重缺陷，他们比富裕人群戒烟的可能性更小，而且戒烟后复吸的可能性更大。此应用程序的目标是检查旨在减少美国退伍军人管理局 (VHA) 地区医疗保健系统内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病护理模式的主动、个性化、协调的护理系统（连接到戒烟（CTQ））。 CTQ 将吸烟视为一种慢性疾病，与高血压或糖尿病一样，需要通过行为疗法和药物疗法的适当组合进行长期治疗。 CTQ 将在 3 VA 匹兹堡医疗保健系统 (VAPHS) 医疗实践的背景下进行评估，该系统为约 2,400 名低收入吸烟者提供护理，其中 93% 的家庭年收入低于 36,000 美元（27% 的收入低于 1 万美元；37% 的收入为 10-19,999 万美元；23% 的收入为 20-29,999 万美元；只有 13% 的家庭年收入低于 36,000 美元） > 30,000 美元）。 VAPHS 中大约 40 名初级保健提供者（PCP，包括非医生）（及其年收入 < 36,000 美元的低收入患者）将被随机分配接受 CTQ 或普通护理（UC、现有 VHA 服务，无额外 CTQ 服务）。参与该研究并不需要有戒烟意愿，因为 CTQ 的目的是让处于戒烟准备程度的吸烟者参与进来。每组中约有 480 名低收入吸烟者预计将参与研究并接受至少 2 年的跟踪。研究人员将在 2 年后和 2 年内（每 6 个月测量一次）测量戒断情况（经生化验证的 30 天点患病率）。将评估直接和间接护理成本，以计算每次成功戒烟 CTQ 与 UC 的增量成本。研究人员将探讨与治疗利用和行为过程（登记的患者和提供者）相关的过程测量对 CTQ 影响的中介作用。 该提案由新研究员 Tindle 博士领导，代表了具有互补专业知识、经验和定位的研究人员共同努力来执行这项研究。保守估计，CTQ 在两年内使戒烟率比 UC 提高约 5%（代表戒烟率增加 50-100%），这将导致全国 VA 低收入退伍军人人口中的低收入吸烟者减少约 50,000 人，如果在全国范围内预测所有低收入吸烟者，则减少约 300,000 人。