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

• 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
• 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

 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（由申请人提供）：与将美国总体吸烟率从20世纪60年代的> 50%降低到2000年的约20%的公共卫生成就相比，患有严重精神疾病（SMI）的人的吸烟率仍然是普通人群的2-3倍。最近的数据表明，在过去十年中，在一般人群中发生的吸烟率的任何小幅下降都没有在患有重度精神病的吸烟者中看到。事实上，美国44%的香烟消费者是精神疾病患者，而精神疾病患者的头号死因是烟草相关疾病。不幸的是，<25%的SMI吸烟者因其烟草使用障碍（TUD）而接受循证治疗。改造公共精神卫生基础设施，以遵守提供循证TUD治疗的指南，是NIMH的优先事项，也是国家努力实现2020年健康人群烟草使用目标的一部分。目前FDA批准的TUD药物和基于指南的行为戒烟治疗对患有SMI的吸烟者安全有效，公共精神卫生机构是整合TUD治疗的理想场所。然而，系统性（例如，缺乏培训）和文化（例如，精神卫生保健系统内的障碍（认为戒烟会导致失代偿）正在阻止患有SMI的吸烟者接受循证TUD治疗。促进公共精神卫生诊所内TUD循证实践的采用和可持续性，需要组织层面的干预，以解决阻碍有效护理的障碍。初步研究 研究小组成员在社区精神卫生保健环境中进行的研究表明，组织层面的干预减少了提供循证TUD治疗的障碍，并提高了临床医生对治疗指南的依从性。因此，采用随机分组设计和16个社区精神卫生保健机构（N=320名工作人员，N=800名客户），本研究将评估通过组织变革解决烟草问题（ATTOC）模型：1）提高提供者对治疗TUD指南的依从性; 2）与常规护理（UC）相比，降低客户吸烟率。非劣效性检验将确定与UC相比，ATTOC模型是否对客户心理健康功能产生不利影响，并将评估ATTOC干预的成本效益。我们还将探讨障碍的变化，作为ATTOC模型对提供者遵守治疗指南和患者吸烟的影响的中介，并确定与更容易传播的改善结果相关的关键ATTOC组件。如果这项试验表明，ATTOC可以促进对TUD的循证护理，并降低SMI患者的吸烟率-而不会恶化心理健康并以具有成本效益的方式-这种组织变革模式可能是解决吸烟者中服务不足亚组的烟草使用问题的关键举措，并有助于实现2020年健康人烟草使用目标。