Extended Care for Smoking Cessation Following Psychiatric Hospitalization

精神病住院后戒烟的长期护理

• 批准号: 8764487
• 负责人: RICHARD A BROWN
• 金额: $ 68.08万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8764487
• 关键词: Abstinence; Accident and Emergency department; Adult; Back; Behavioral; Cigarette; Clinical Trials Design; Clinical effectiveness; Cotinine; Counseling; Diagnosis; Diagnostic; Education; Effectiveness; Future; General Population; Goals; Health; Health system; Hospitalization; Hospitals; Individual; Inhalators; Inpatients; Intervention; Life; Long-Term Care; Longevity; Medical; Mental Health; Mental disorders; Modeling; Morbidity - disease rate; Nicotine; Nicotine Inhaler; Outcome; Outpatients; Participant; Patient Education; Patients; Pharmaceutical Preparations; Pharmacotherapy; Prevalence; Professional counselor; Psychiatric Hospitals; Psychiatric therapeutic procedure; Psychotherapy; Public Health; Randomized; Relative (related person); Research; Sampling; Services; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Specific qualifier value; Subgroup; Symptoms; System; Telephone; Testing; Tobacco; Visit; Voice; Withholding Treatment; comparative effectiveness; computerized; cost; cost effective; design; effectiveness trial; evidence base; experience; health care service utilization; hospital readmission; improved; inpatient psychiatric treatment; mortality; nicotine patch; nicotine replacement; public health priorities; public health relevance; quitline; response; service intervention; severe mental illness; smoking cessation; smoking intervention; standard care; tobacco abstinence

DESCRIPTION (provided by applicant): Smoking rates among individuals with psychiatric disorders are disproportionately higher than the general population. In fact, these individuals are estimated to consume almost half (44.3%) of all cigarettes smoked in the U.S. and have lifespans 25 - 32 years shorter than the general population. In 2011, 1.8 million U.S. adults, including 7.2% of adults with severe mental illness (SMI), received inpatient psychiatric treatment. The majority of psychiatric hospitals ban smoking on hospital grounds, thus providing an opportunity for inpatients to experience abstinence. Yet smokers in inpatient psychiatric settings are infrequently provided with referrals for cessation treatment on discharge (< 1 %) and most resume smoking upon discharge. Therefore, the integration of effective cessation interventions within the current mental health treatment system is a public health priority. We have recently described and have now completed a comparative effectiveness trial in hospitalized medical patients, comparing Standard Care to an Extended Care smoking intervention that provided up to 3 months of smoking cessation medication at no cost to patients and 5 proactive, computerized telephone calls during which patients could request to receive a call back from a live counselor. This Extended Care service demonstrated clinical effectiveness, yielding significantly greater biochemically-verified, point prevalence abstinence relative to Standard Care, 6 months after hospital discharge. The overall objective of this project is to adapt this Extended Care (ExC) model to smokers with SMI engaged in a psychiatric hospitalization and to conduct a randomized, pragmatic effectiveness trial designed to assess the benefit of this adapted ExC in real-world practice. We will test the hypothesis that, among smokers with SMI in inpatient psychiatric treatment (n = 422), ExC will result in significantly greater rates of cotinine- validated, 7-day point prevalence abstinence at 6- and 12-months compared to a group that receives Brief Education (BE) about smoking cessation. Furthermore, we hypothesize that a higher proportion of ExC vs. BE patients will use evidence-based smoking cessation treatment (counseling and pharmacotherapy) in the month after discharge. We will also explore the effect of ExC on health and health care utilization in the 12 months post-discharge (psychiatric symptoms, psychiatric and medical hospital readmissions and emergency room visits) and the effectiveness of ExC on smoking abstinence in patient diagnostic subgroups. The expected outcome of this project is a demonstration of the effectiveness of an Extended Care intervention for smoking cessation in individuals with SMI following psychiatric hospitalization. Future studies could extend these findings to individuals with SMI receiving outpatient psychiatric treatment or psychotherapy. Overall, this research would have a significant positive public health impact that will move us closer to the long- term goal of dissemination and integration of the Extended Care model to increase smoking cessation and decrease smoking related morbidity and mortality in people with severe mental illness.

描述（由申请人提供）：精神疾病患者的吸烟率明显高于一般人群。事实上，这些人都是 据估计，他们消费了美国几乎一半（44.3%）的香烟，并且寿命比一般人群短 25 - 32 年。 2011年，180万美国成年人接受了住院精神病治疗，其中7.2%患有严重精神疾病(SMI)。大多数精神病医院都以医院为由禁止吸烟，从而为住院患者提供了戒烟的机会。然而，住院精神病院的吸烟者在出院时很少获得戒烟治疗转诊（< 1%），并且大多数人在出院后又恢复吸烟。因此，将有效的戒烟干预措施纳入当前的心理健康治疗体系是公共卫生的首要任务。我们最近描述并现已完成了一项针对住院患者的有效性比较试验，将标准护理与延伸护理吸烟干预进行了比较，后者为患者免费提供长达 3 个月的戒烟药物，并提供 5 个主动的计算机化电话，在此期间患者可以请求接收现场咨询师的回电。这项延伸护理服务证明了临床有效性，出院 6 个月后，相对于标准护理，经生化验证的点戒断率显着提高。 该项目的总体目标是使这种延伸护理 (ExC) 模式适用于接受精神病住院治疗的 SMI 吸烟者，并进行随机、务实的有效性试验，旨在评估这种经过调整的 ExC 在现实世界实践中的益处。我们将检验这样一个假设：在住院精神科治疗中患有 SMI 的吸烟者 (n = 422) 中，与接受戒烟简短教育 (BE) 的组相比，ExC 将导致 6 个月和 12 个月时经过可替宁验证的 7 天点戒烟率显着提高。此外，我们假设与 BE 患者相比，ExC 患者在出院后一个月内会使用循证戒烟治疗（咨询和药物治疗）的比例更高。我们还将探讨 ExC 对出院后 12 个月内健康和医疗保健利用的影响（精神症状、精神科和内科医院再入院以及急诊室就诊）以及 ExC 对患者诊断亚组戒烟的有效性。 该项目的预期成果是证明长期护理干预对于精神科住院后 SMI 患者戒烟的有效性。未来的研究可以将这些发现扩展到接受门诊精神病治疗或心理治疗的 SMI 患者。总体而言，这项研究将对公共卫生产生重大积极影响，使我们更接近传播和整合延伸护理模式的长期目标，以提高严重精神疾病患者的戒烟率并降低吸烟相关的发病率和死亡率。