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: 8996007
• 负责人: Hilary A. Tindle
• 金额: $ 43.88万
• 依托单位: VANDERBILT UNIVERSITY
• 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 2016-04-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8996007
• 关键词: Connect; Quit; Coordinated; Care; Smoking

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(申请人提供)：尽管在过去的40年里，美国成年人的吸烟流行率有所下降，但在低收入成年人和美国军队低收入退伍军人中，吸烟的流行率仍然很高。尽管退伍军人管理局(VHA)卫生保健系统采取了高度先进的、以人口为基础的烟草控制方法，但低收入吸烟者仍然难以治疗。在全国范围内，普遍缺乏将吸烟作为一种慢性病的方法，即使在最好的情况下，每个吸烟者也会有很高的复发率和多次戒烟尝试，这是目前针对低收入吸烟者的护理标准的一个严重缺陷，这些吸烟者戒烟的可能性甚至低于较富裕的人，而且在戒烟后更有可能复发。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)区域医疗保健系统内低收入成年人吸烟的干预措施的有效性。 我们提出了一个积极的，个性化的，协调的护理系统(连接到戒烟(CTQ))，它植根于慢性护理模式。CTQ将吸烟视为一种慢性疾病，与高血压或糖尿病一样，需要通过适当的行为疗法和药物疗法的适当组合进行长期治疗。CTQ将在3个VA匹兹堡医疗系统(VAPHS)医疗诊所的背景下进行评估，这些诊所为大约2,400名低收入吸烟者提供服务，其中93%的人报告家庭年收入低于36,000美元(27%的人年收入低于36,000美元；37%的人年收入在10-19,999K美元；23%的人年收入在20-29,999K美元；只有13%的人年收入低于30,000美元)。约40名VAPHS的初级保健提供者(包括非医生)(及其年收入为36,000美元的低收入患者)将被随机分配到CTQ或普通护理(UC，现有的VHA服务，没有额外的CTQ服务)。参与这项研究并不需要戒烟意愿，因为CTQ的目的是让吸烟者参与到戒烟的各个级别。每组大约480名低收入吸烟者预计将登记并被跟踪至少两年。研究人员将在两年结束时和两年期间(每6个月测量一次)测量禁欲(生化验证的30天点流行率)。将评估直接和间接护理成本，以计算CTQ与UC的每次成功戒烟的增量成本。研究人员将探索与治疗利用和(登记患者和提供者的)行为过程相关的过程措施对CTQ影响的中介作用。 这项建议由Tindle博士领导，他是一名新的研究人员，代表着具有互补专业知识、经验和定位的研究人员共同努力执行这项研究。保守估计，CTQ在两年内将戒烟率提高约5%，超过UC(相当于戒烟率增加50%-100%)，将导致低收入退伍军人中全国退伍军人中的低收入吸烟者减少约50,000人，如果在全国范围内预计所有低收入吸烟者将减少约300,000人。