Implementing tobacco use treatment guidelines in community health centers in Viet

摘要 越南的吸烟率在东南亚国家(SEAC)中排名第二。 越南约有9000万人口，成人总人数也位居第二 海上吸烟者(超过1600万)。根据世界卫生组织(WHO)的数据，在 在不久的将来，将通过帮助目前的吸烟者戒烟来实现烟草使用造成的死亡率。烟草使用 治疗，由美国预防卫生服务指南(指南)定义的烟草使用 和依赖性，是以证据为基础的，具有很高的成本效益。然而，在美国和全球，采用 推荐的护理方案不是最理想的。这项建议的目标是填补目前研究与实践之间的差距。 通过进行随机对照试验，比较两种药物的有效性和成本效益 执行以证据为基础的治疗指南的实用和高度可复制的战略 越南公共卫生诊所的烟草使用情况。拟议的实施策略基于以下证据： 基于方法，以及世界卫生组织最近发布的实施框架第14条的指南 烟草控制公约(烟草控制公约)。《烟草控制框架公约》是一项基于证据的条约，由 世卫组织应对烟草流行的全球化。越南于2004年批准了《烟草控制框架公约》；然而， 他们尚未采取措施执行第14条，该条规定有必要将最佳做法 将烟草使用和依赖纳入常规预防护理。拟议的实施战略 也建立在越来越多的文献的基础上，这些文献支持将社区卫生工作者整合为 卫生保健小组成员，以改善获得预防性服务的机会。我们提出了一种双臂集群 一项随机对照试验，将比较两种多组分的有效性和成本效益 实施烟草使用治疗指南的战略：1)技术援助、培训和临床 提醒系统(TTC)与TTC+转诊至社区卫生工作者(CHW)。主要结果是 供应商遵守烟草使用治疗指南(执行效果)。第二个 结果是经过生化验证的六个月戒烟。我们将先行进行形成性评估 从实施到评价，以评估当前的政策、护理制度和实践层面的障碍以及 公共卫生诊所烟草使用筛查和治疗的促进者，并通知对 实施战略。在创新实施的组织模式指导下，我们还将 审查与有效实施供应商遵守烟草使用规定相关的组织因素 治疗指南。这项研究将在两个地区(农村和城市)的26个公共卫生诊所进行。 这项研究的长期目标是提供关键的新知识，以促进 实施、传播和持续利用循证烟草使用治疗战略 在全球和美国

ABSTRACT Vietnam has a smoking prevalence that is the second highest among South East Asian countries (SEACs). With a population of approximately 90 million, Vietnam also has the second largest total number of adult smokers (over 16 million) in SEA. According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Tobacco use treatment, as defined by the U.S. Preventive Health Service Guideline (Guideline) on Treating Tobacco use and Dependence, is evidence-based and highly cost-effective. Yet, in the U.S. and globally, adoption of recommended care is suboptimal. The objective of this proposal is to fill the current research-to-practice gap by conducting a randomized controlled trial that compares the effectiveness and cost effectiveness of two practical and highly replicable strategies for implementing evidence-based guidelines for the treatment of tobacco use in public health clinics in Vietnam. The proposed implementation strategies draw on evidence- based approaches, and the WHO's recently released guidelines for implementing Article 14 of the Framework Convention on Tobacco Control (FCTC). The FCTC is an evidence-based treaty that was developed by the WHO in response to the globalization of the tobacco epidemic. Vietnam ratified the FCTC in 2004; however, they have not taken steps to implement Article 14 which specifies the need to integrate best practices for treating tobacco use and dependence into routine preventive care. The proposed implementation strategies also build on the growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We propose a two arm, cluster randomized controlled trial that will compare the effectiveness and cost effectiveness of two multi component strategies for implementing tobacco use treatment guidelines: 1) Technical assistance, training, plus clinical reminder system (TTC) vs. 2) TTC + referral to a community health worker (CHW). The primary outcome is provider adherence to tobacco use treatment guidelines (implementation effectiveness). The secondary outcome is six month biochemically verified smoking abstinence. We will conduct a formative evaluation prior to implementation to evaluation to assess current policies, systems of care and practice-level barriers and facilitators for tobacco use screening and treatment in public health clinics and inform modifications to the implementation strategies. Guided by an organizational model of innovation implementation, we will also examine organizational factors associated with effective implementation of provider adherence to tobacco use treatment guidelines. The study will be conducted in 26 public health clinics in two districts (rural and urban). The long-term goal of this research is to provide critical new knowledge to facilitate the widespread implementation, dissemination and sustained utilization of evidence-based tobacco use treatment strategies globally and in the U.S.