Proactive Outreach for Smokers in VA Mental Health

描述(由申请人提供)： 为退伍军人管理局心理健康领域的吸烟者提供积极主动的服务背景：在美国，烟草使用是可预防的主要死亡原因，占退伍军人管理局所有医疗费用的24%。参加退伍军人医疗保健系统的退伍军人吸烟比普通人群多得多，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，包括尼古丁依赖程度高、转诊的随访率低，以及根据其需要量身定做的烟草治疗有限。理由：大多数医疗保健提供者评估烟草使用情况并建议吸烟者戒烟，但他们没有足够的时间进行后续治疗，导致 长期戒烟率较低。经常与患者定期会面的精神健康提供者报告说，他们发现戒烟超出了他们的执业范围，既不评估烟草使用情况，也不转介吸烟者接受治疗。即使使用密集的方法并跨越各种设置和提供者类型，这些实践模式也很难改变。因此，我们建议使用电子病历系统来识别接受心理健康护理的吸烟者，并根据以下具体目标主动伸出援手，让他们接受治疗：1.比较主动外展电话戒烟(PRO)计划对精神健康患者的覆盖范围和有效性，以及向当地退伍军人管理局和社区戒烟资源提供的常规护理(UC)建议和转介。2.在PRO和UC条件下，在6个月和12个月时，基线社会人口学、医学和心理健康特征与禁欲之间的纵向关联模型。方法：我们将使用电子病历来识别4个退伍军人管理局医疗机构的N=6400名患者，他们在过去一年中有一个临床提醒代码，表明目前使用烟草的情况，并在过去6个月内进行过精神健康访问。我们将给每个患者寄一封介绍信和基线调查。受访者将以1：1的方式随机分为干预或对照。对照组参与者将接受退伍军人管理局的常规护理。干预参与者将接受积极的电话咨询和戒烟药物。我们将在注册后6个月和12个月评估烟草使用情况。主要结果是在12个月的随访中禁欲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.