Testing an Organizational Change Model to Address Smoking in Mental Healthcare

测试组织变革模型以解决心理保健中的吸烟问题

基本信息

批准号：
9886075
负责人：
Robert A Schnoll
金额：
$ 63.77万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-03-02 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9886075
关键词：
Achievement Address Adherence Adoption Affect American Behavior Therapy Behavioral Belief Bipolar Disorder Caring Cause of Death Cigarette Client Clinic Clinical Practice Guideline Clinical Trials Clinical Trials Design Communities Community Healthcare Consumption Cost Analysis Data Disease Evidence based practice Evidence based treatment FDA approved General Population Goals Guidelines Health Personnel Health care facility Healthcare Healthcare Systems Healthy People 2020 Human Resources Individual Infrastructure Intervention Life Link Major Depressive Disorder Measures Mediator of activation protein Mental Health Mental disorders Mentally Ill Persons Methods Modeling Morbidity - disease rate National Institute of Mental Health Nicotine Dependence Organizational Change Patients Persons Pharmaceutical Preparations Provider Psyche structure Public Health Quality of life Randomized Randomized Clinical Trials Reporting Research Schizophrenia Smoker Smoking Smoking Cessation Intervention Source Specialist Subgroup Testing Time Tobacco Tobacco Use Disorder Tobacco use Training United States Public Health Service adherence rate barrier to care base cost effective cost effectiveness cost-effectiveness ratio design evidence base evidence based guidelines follow-up health care service organization health care settings improved improved outcome incremental cost-effectiveness member mortality novel prevent programs public health relevance reinforcer severe mental illness smoking cessation time use tobacco control treatment as usual treatment guidelines varenicline

项目摘要

DESCRIPTION (provided by applicant): In contrast to the public health achievement of reducing overall US smoking rates from >50 percent in the 1960s to ~20 percent by 2000, the rate of smoking among those with serious mental illness (SMI) remains 2-3 times greater than in the general population. Recent data has shown that any small decline in smoking rates occurring in the general population in the past decade has not been seen among smokers with an SMI. In fact, 44 percent of all the cigarettes consumed in the US are by individuals with a psychiatric disorder and the number one cause of death among Americans with a psychiatric disorder is a tobacco-related disease. Unfortunately, < 25 percent of smokers with SMI receive evidence-based treatment for their tobacco use disorder (TUD). Transforming the public mental healthcare infrastructure to adhere to guidelines for the provision of evidence-based TUD treatment is an NIMH priority and is part of a national effort to meet Healthy People 2020 target goals for tobacco use. Current FDA-approved medications for TUD and guideline-based behavioral smoking cessation treatments are safe and efficacious for smokers with SMI and public mental healthcare facilities are ideal settings for integrating TUD treatments. Yet, systemic (e.g., lack of training) and cultural (e.g., belief that smoking cessation will cause decompensation) barriers within the mental healthcare system are preventing smokers with SMI from receiving evidence-based TUD treatment. Facilitating the adoption and sustainability of evidence-based practice for TUD within public mental healthcare clinics requires an organization-level intervention to address barriers that hinder effective care. Preliminary studies by members of the research team in community mental healthcare settings have shown that an organization-level intervention reduces barriers to providing evidence-based TUD treatment and improves clinician adherence to treatment guidelines. Thus, with a cluster-randomized design and 16 community mental healthcare agencies (N=320 personnel, N=800 clients), this study will evaluate the Addressing Tobacco Through Organizational Change (ATTOC) model for: 1) improving provider adherence to guidelines for treating TUD; and 2) reducing client smoking rates, vs. usual care (UC). Non-inferiority testing will determine if the ATTOC model adversely affects client mental health functioning, vs. UC, and the cost-effectiveness of the ATTOC intervention will be assessed. We will also explore changes in barriers as mediators of the effects of the ATTOC model on provider adherence to treatment guidelines and patient smoking and identify key ATTOC components linked to improved outcomes that can be more easily disseminated. If this trial shows that ATTOC can promote evidence-based care for TUD and reduce smoking rates for those with an SMI - and without worsening mental health and in a cost- effective manner - this organizational change model may represent a critical initiative to address tobacco use in an under-served sub-group of smokers and help to attain Healthy People 2020 tobacco use goals.

描述（由适用提供）：与将美国总体吸烟率从1960年代> 50％降低到2000年的公共卫生成就相反，到2000年，患有严重精神疾病（SMI）的吸烟率（SMI）的吸烟率是一般人群的2-3倍。最近的数据表明，在过去的十年中，普通人群中的吸烟率较小，在患有SMI的吸烟者中没有看到。实际上，在美国消耗的所有香烟中，有44％是患有精神障碍的人，患有精神疾病的美国人的死亡原因是与烟草有关的疾病。不幸的是，<25％的SMI吸烟者因其烟草使用障碍（TUD）接受基于证据的治疗。将公共心理保健基础设施转变为遵守提供循证TUD治疗的准则是NIMH的优先事项，并且是满足健康人2020年健康人2020年目标目标目标的一部分。当前用于TUD和基于指南的行为戒烟治疗的FDA批准药物对于患有SMI和公共心理保健设施的吸烟者是安全有效的，是整合TUD治疗的理想环境。然而，系统性（例如，缺乏培训）和文化（例如，认为戒烟会导致障碍物在心理保健系统中导致代偿性障碍）正在阻止吸烟者接受SMI的吸烟者接受基于证据的TUD治疗。促进在公共心理保健诊所内的TUD基于循证实践的采用和可持续性需要组织水平的干预措施，以应对阻碍有效护理的障碍。初步研究社区心理保健环境中研究团队的成员表明，组织级的干预措施减少了提供基于证据的TUD治疗的障碍，并改善了临床遵守治疗指南。通过集群随机设计和16个社区心理保健机构（n = 320人，n = 800个客户），本研究将通过组织变革（ATTOC）模型评估：1）改善提供者对治疗TUD的指南的依从性； 2）降低客户的吸烟率，与通常的护理（UC）。非效率测试将确定ATTOC模型是否会对客户的心理健康功能（与UC）进行不利影响，并且将评估ATTOC干预的成本效益。我们还将探索障碍的变化，作为ATTOC模型对提供者遵守治疗指南和患者吸烟的影响的介体，并确定与改进结果相关的关键ATTOC组件，这些成分可以更容易传播。如果该试验表明，ATTOC可以促进具有SMI患者的TUD的循证护理并降低吸烟率，而不必担心心理健康，并且以具有成本效益的方式，这种组织变革模型可能代表了一个关键的计划，以解决服务不足的吸烟者中使用烟草的使用，并帮助获得健康的人2020烟草使用2020烟草使用目标。