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。 越南人口约9000万，也是成年人总数第二多的国家。 吸烟者（超过1600万）在东南亚。根据世界卫生组织（世卫组织）， 在不久的将来，将通过帮助目前的吸烟者戒烟来降低烟草使用造成的死亡率。烟草使用 治疗，如美国预防健康服务指南（指南）关于治疗烟草使用的定义 和依赖性，是以证据为基础的，具有高度的成本效益。然而，在美国和全球， 建议的护理是次优的。这项建议的目的是填补目前的研究到实践的差距 通过进行一项随机对照试验，比较两种药物的有效性和成本效益， 实施循证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。拟议的实施战略借鉴了证据- 以及世卫组织最近发布的执行《框架》第14条的准则 烟草控制公约（FCTC）。《烟草控制框架公约》是一项以证据为基础的条约， 世卫组织对烟草流行全球化的反应。越南于2004年批准了FCTC;然而， 他们没有采取措施执行第14条，该条规定需要整合最佳做法， 将烟草使用和依赖纳入常规预防护理。拟议的实施战略 还建立在越来越多的文献，支持整合社区卫生工作者的有效性， 卫生保健小组的成员，以改善获得预防服务。我们提出一个双臂，集群 一项随机对照试验，将比较两种多组分药物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，加上临床 提醒系统（TTC）与2）TTC +转介给社区卫生工作者（CHW）。主要结局是 提供者遵守烟草使用治疗指南（实施有效性）。次级 结果是六个月的生物化学验证戒烟。我们将进行形成性评估， 从实施到评价，以评估当前的政策、护理系统和实践层面的障碍， 促进公共卫生诊所的烟草使用筛查和治疗， 执行战略。在创新实施的组织模式的指导下，我们还将 检查与有效实施供应商遵守烟草使用相关的组织因素 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，以促进广泛的 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.