Proactive Outreach for Smokers in VA Mental Health

描述（由申请人提供）： 吸烟者在弗吉尼亚州精神健康的主动外展背景：烟草使用是美国主要的可预防的死亡原因，占弗吉尼亚州所有医疗保健费用的24%。在退伍军人管理局医疗保健系统登记的退伍军人吸烟大大超过一般人群，这在被诊断患有精神疾病的退伍军人中尤其如此。双相情感障碍或精神分裂症患者的吸烟率最高（分别为69%和58- 90%），其次是创伤后应激障碍（45-63%）和抑郁症（31-51%）。在精神健康患者中存在许多戒烟障碍，包括尼古丁依赖性高，转诊跟进率低，以及针对其需求的烟草治疗有限。基本原理：大多数医疗服务提供者评估烟草使用并建议吸烟者戒烟，但他们没有足够的时间进行后续治疗，导致 长期戒烟率低。经常与患者定期会面的心理健康提供者报告说，他们发现戒烟超出了他们的实践范围，既不评估烟草使用，也不推荐吸烟者接受治疗。这些实践模式很难改变，即使使用密集的方法，并跨越各种设置和提供者类型。因此，我们建议透过电子病历系统，识别正在接受精神健康护理的吸烟者，并主动接触他们，让他们参与治疗，目的如下：比较针对精神健康患者的主动外展电话戒烟（PRO）计划与常规护理（UC）建议和转介当地VA和社区戒烟资源的覆盖范围和有效性。2. PRO和UC条件下基线社会人口统计学、医学和心理健康特征与6个月和12个月时禁欲之间的纵向关联模型。研究方法：我们将使用电子病历识别4家VA医疗机构的N= 6，400名患者，这些患者具有临床提醒代码，表明过去一年中当前的烟草使用情况，并且在过去6个月内进行了心理健康访视。我们将向每位患者发送介绍信和基线调查。受访者将以1：1的比例随机分配至干预组或对照组。对照组受试者将接受VA常规护理。干预参与者将接受积极的电话咨询和戒烟药物。我们将在入组后6个月和12个月评估烟草使用情况。主要结局是在12个月随访时禁欲30天。

DESCRIPTION (provided by applicant): Proactive Outreach for Smokers in VA Mental Health Background: Tobacco use is the leading preventable cause of death in the United States and contributes up to 24% of all VA healthcare costs. Veterans enrolled in the VA healthcare system smoke substantially more than the general population, which is particularly true among Veterans diagnosed with mental illness. Patients with bipolar disorder or schizophrenia have the highest smoking rates (69% and 58-90%, respectively) followed by those with PTSD (45-63%) and depression (31-51%). Numerous barriers exist for tobacco cessation among mental health patients, including high nicotine dependency, low rates of follow through for referrals, and limited availability of tobacco treatment tailored to their needs. Rationale: Most medical care providers assess tobacco use and advise smokers to quit, but they have insufficient time to follow up with treatment, leading to low long-term quit rates. Mental health providers who often meet regularly with patients report that they find tobacco cessation outside the scope of their practice and neither assess tobacco use nor refer smokers for treatment. These practice patterns have been very difficult to change even with intensive methods and across various settings and provider types. Therefore, we propose to use the electronic medical record system to identify smokers receiving mental health care and proactively reach out to engage them in treatment in line with the following aims: Specific Aims: 1. Compare the reach and efficacy of a proactive outreach telephone-based tobacco cessation (PRO) program for patients seen in mental health to usual care (UC) advice and referral to local VA and community tobacco cessation resources. 2. Model longitudinal associations between baseline sociodemographic, medical and mental health characteristics and abstinence at 6 and 12 months in the PRO and UC conditions. Methods: We will use the electronic medical record to identify N=6,400 patients across 4 VA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past year and who have had a mental health visit in the past 6 months. We will send each patient an introductory letter and baseline survey. Respondents will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VA usual care. Intervention participants will receive proactive telephone counseling and cessation medications. We will assess tobacco use at 6 and 12 months from enrollment. The primary outcome is 30-day abstinence at the 12-month follow-up.