Proactive Outreach for Smokers in VA Mental Health

退伍军人管理局心理健康部门积极主动为吸烟者提供服务

• 批准号: 8484925
• 负责人: STEVEN FU
• 金额: --
• 依托单位: VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8484925
• 关键词: Abstinence; Address; Baseline Surveys; Behavior; Bipolar Disorder; Caring; Cause of Death; Cessation of life; Characteristics; Chronic; Cigarette; Clinical; Code; Communities; Computerized Medical Record; Control Groups; Counseling; Dependency; Diagnosis; Distress; Educational Technics; Enrollment; General Population; Health; Health Care Costs; Health Personnel; Health care facility; Healthcare; Healthcare Systems; Intervention; Letters; Medical; Medical Records; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Morbidity - disease rate; Nicotine; Participant; Patient Participation Rates; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Populations at Risk; Post-Traumatic Stress Disorders; Prevention program; Primary Health Care; Problem Solving; Provider; Psyche structure; Public Health; Randomized; Randomized Controlled Trials; Relapse; Reporting; Research; Research Infrastructure; Resources; Respondent; Schedule; Schizophrenia; Services; Smoke; Smoker; Smoking; Stress; Substance abuse problem; System; Telephone; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Treatment Protocols; United States; Veterans; Visit; Withholding Treatment; base; cost effective; evidence base; experience; follow-up; health practice; improved; meetings; novel; outreach; patient population; primary outcome; programs; smoking cessation; smoking prevalence; treatment as usual; treatment program; uptake

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.

描述（由申请人提供）： VA心理健康背景中吸烟者的积极宣传：烟草使用是美国的主要可预防原因，最多占所有VA医疗保健费用的24％。参加VA医疗保健系统烟雾的退伍军人比一般人群大得多，这在被诊断出患有精神疾病的退伍军人中尤其如此。躁郁症或精神分裂症患者的吸烟率最高（分别为69％和58-90％），其次是PTSD（45-63％）和抑郁症（31-51％）。精神卫生患者中存在许多障碍，包括高尼古丁依赖性，转介的较低率以及适合其需求量的烟草治疗的有限可用性。理由：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治疗，导致 长期戒烟率低。经常与患者经常会面的心理健康提供者报告说，他们在实践范围之外发现了烟草停止，并且既不评估烟草使用也不会引起吸烟者进行治疗。即使使用密集的方法以及各种环境和提供商类型，这些实践模式也很难改变。因此，我们建议使用电子医疗记录系统来确定接受心理保健的吸烟者，并主动伸出援助他们以以下目的使他们参与治疗：具体目的：1。比较基于外展开电话的烟草戒烟计划的覆盖范围和功效（PRO）在心理健康方面的患者（PRO）计划，从而在精神健康方面与本地护理（UC）建议（UC）咨询和社区va和社区va和社区cocecation和社区。 2。在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戒酒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VA医疗机构中的n = 6,400名患者，这些医疗机构具有临床提醒代码，指示过去一年中当前使用烟草，并且在过去6个月中进行了心理健康访问。我们将向每个患者发送介绍信和基线调查。受访者将以1：1的方式随机分配干预或控制。控制参与者将获得VA常规护理。干预参与者将获得积极的电话咨询和戒烟药物。我们将在入学后6个月和12个月内评估烟草使用。主要结果是在12个月的随访中节制30天。