Extended Care for Smoking Cessation Following Psychiatric Hospitalization

精神病住院后戒烟的长期护理

• 批准号: 8913272
• 负责人: RICHARD A BROWN
• 金额: $ 61.03万
• 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/8913272
• 关键词: Abstinence; Adult; Back; Behavioral; Cigarette; Clinical effectiveness; Cotinine; Counseling; Diagnosis; Diagnostic; Education; Effectiveness; Emergency department visit; 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; 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; quitline; response; service intervention; severe mental illness; smoking cessation; smoking intervention; standard care; tobacco abstinence; trial design

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不成比例地高于一般人群。事实上，这些人 据估计，他们消耗了美国所有吸烟者的近一半（44.3%），寿命比普通人群短25 - 32年。2011年，180万美国成年人，包括7.2%的严重精神疾病（SMI）成年人，接受住院精神病治疗。大多数精神病医院禁止在院内吸烟，从而为住院病人提供了体验禁欲的机会。然而，在住院精神病环境中的吸烟者很少在出院时被转诊接受戒烟治疗（<1%），大多数人在出院后重新开始吸烟。因此，将有效的戒烟干预纳入当前的精神卫生治疗体系是公共卫生的优先事项。我们最近描述并完成了一项在住院医疗患者中进行的比较有效性试验，将标准护理与扩展护理吸烟干预进行比较，扩展护理吸烟干预为患者提供长达3个月的免费戒烟药物和5个主动的计算机电话，在此期间，患者可以要求接受现场顾问的回电。这种扩展护理服务证明了临床有效性，在出院后6个月，与标准护理相比，获得了显著更高的经生化验证的点患病率禁欲率。 本项目的总体目标是使这种扩展护理（ExC）模式适用于精神病住院治疗的SMI吸烟者，并进行一项随机、务实的有效性试验，旨在评估这种适应性ExC在现实世界实践中的获益。我们将检验以下假设：在住院精神病治疗的SMI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个月时经可替宁验证的7天时点戒烟率显著更高。此外，我们假设在出院后的一个月内，ExC患者比BE患者使用循证戒烟治疗（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、精神病和内科再入院和急诊室就诊），以及ExC对患者诊断亚组戒烟的有效性。 该项目的预期结果是证明扩展护理干预对精神科住院后重度精神分裂症患者戒烟的有效性。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。总的来说，这项研究将对公共卫生产生重大的积极影响，这将使我们更接近长期目标，即传播和整合扩展护理模式，以增加戒烟和降低严重精神疾病患者与吸烟相关的发病率和死亡率。