Implementation of Cessation Treatment in Community Based Mental Health Centers

在社区精神卫生中心实施戒烟治疗

• 批准号: 10304860
• 负责人: Sandra Jane Japuntich
• 金额: $ 20.21万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10304860
• 关键词: Abstinence; Address; Adjuvant; Bupropion; Caring; Case Management; Chronic Care; Chronic Disease; Clinic; Communities; Contracts; Counseling; Disease Management; Effectiveness; Elements; Feasibility Studies; Feedback; Funding; General Population; Goals; Health Personnel; Health Services Accessibility; Hybrids; Individual; Information Dissemination; Infrastructure; Intervention; Interview; Laboratories; Leadership; Measures; Medication Management; Mental Health; Mental disorders; Modeling; Monitor; Outcome; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacotherapy; Pilot Projects; Practical Robust Implementation and Sustainability Model; Prevalence; Provider; Psychiatric Diagnosis; Public Health; Relapse; Reporting; Research; Resources; Rhode Island; Risk; Safety; Science; Self Management; Service delivery model; Services; Site; Smoker; Smoking; Surveys; System; Technology Transfer; Telephone; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Training; United States Public Health Service; United States Substance Abuse and Mental Health Services Administration; acceptability and feasibility; addiction; base; chronic care model; cost effective; effectiveness implementation trial; efficacious treatment; evidence base; health disparity; implementation outcomes; implementation strategy; mental health center; mortality; multidisciplinary; nicotine replacement; outreach; patient subsets; pilot test; pilot trial; post implementation; primary outcome; provider intervention; psychiatric symptom; response; severe mental illness; smoking cessation; smoking prevalence; smoking-related disease; substance use prevention; telephone coaching; tobacco cessation intervention; tobacco user; treatment services; treatment strategy; trial design; varenicline

PROJECT SUMMAY / ABSTRACT BACKGROUND: The US Public Health Service (USPHS) designated tobacco dependence as a chronic disease. This is especially true for smokers with serious mental illness (SMI) who make more cessation attempts and are less successful sustaining long-term abstinence than the general population. There is a significant health disparity wherein individuals with SMI have a higher tobacco use prevalence and a greater risk for tobacco-related mortality than the general population. Chronic care models suggest chronic disease management requires a multidisciplinary care team to assess tobacco use, administer treatment, support patient self-management, and monitor progress. Proactive telephone outreach to smokers and brief provider interventions are two effective chronic disease management strategies. Community based mental health centers (CMHCs) are a primary treatment access point for many smokers with SMI. However, rates of intervention with smoking by CMHC providers are low. In order to implement the chronic care model for tobacco dependence for CMHCs, comprehensive implementation strategies are needed. OBJECTIVE: In response to PAR-18-223 we propose formative research and a feasibility pilot trial to adapt an implementation strategy developed by the SAMHSA-funded network of Addiction Technology Transfer Centers (ATTCs) to integrate a proactive, chronic care model of tobacco cessation treatment into CMHCs. AIMS: This study has 3 aims: (1) Adapt an evidence-based implementation strategy to CMHCs. (2) Pilot test the implementation strategy. (3) Conduct a pilot trial to assess the feasibility, acceptability and initial effectiveness of the implementation strategy. DESIGN: In A1, we will conduct stakeholder interviews of 22-29 patients, providers and site leaders in 4 CMHCs guided by the Practical, Robust Implementation and Sustainability Model to obtain information about adapting the ATTC science to service laboratory (SSL) implementation strategy. In A2 we will pilot the SSL strategy to implement proactive tobacco-related telephone outreach calls plus brief provider intervention in one CMHC (N=25 patients; N=33-50 providers) to obtain information on feasibility and acceptability over a 3-month implementation period. In A3 we will conduct a pilot hybrid type 2 implementation-effectiveness trial in 3 CMHCs (N=50 patients; 96-130 providers). We will conduct 2 baseline assessments (3 months apart) and outcomes will be assessed at 3, 6, and 12-months post implementation. Outcomes include feasibility, acceptability, effectiveness of the implementation strategy on tobacco cessation treatment utilization (counseling and medication) and patient effectiveness on tobacco cessation (CO confirmed 7-day point prevalence abstinence). SIGNIFICANCE: An effective implementation strategy for tobacco cessation treatment in CMHCs, a widespread model of care delivery, would have enormous public health impact.

项目摘要/摘要 背景资料：美国公共卫生服务(USPHS)将烟草依赖列为慢性疾病 疾病。对于患有严重精神疾病(SMI)的吸烟者来说尤其如此，他们戒烟次数更多 与普通人群相比，维持长期禁欲的尝试和成功程度较低。有一个 显著的健康差距，其中患有SMI的个人烟草使用率更高， 与烟草相关的死亡风险高于普通人群。慢性病护理模式提示慢性病 管理层需要一个多学科护理团队来评估烟草使用、实施治疗、支持 病人自我管理，并监控进展。主动向吸烟者和简要提供商提供电话联系 干预是两种有效的慢性病管理策略。基于社区的心理健康 中心(CMHC)是许多患有SMI的吸烟者的主要治疗接入点。然而，利率 CMHC提供者对吸烟的干预程度较低。为了实施长期护理模式， 为了减少对烟草的依赖，需要制定全面的执行战略。目标：In 响应PAR-18-223，我们建议进行形成性研究和可行性中试以适应实施 由SAMHSA资助的成瘾技术转移中心(ATTC)网络制定的战略 将一种积极主动的慢性护理模式戒烟治疗纳入CMHC。目标：这项研究有3个 目标：(1)使循证实施策略适用于社区卫生服务中心。(二)试点试行 策略。(3)进行试点，评估该方案的可行性、可接受性和初步效果 实施战略。设计：在A1中，我们将对22-29名患者、提供者进行利益相关者访谈 和4个CMHC的现场负责人在实践、稳健的实施和可持续发展模式的指导下 获取有关调整ATTC科学服务实验室(SSL)实施战略的信息。在……里面 A2我们将试行SSL策略，以实施与烟草有关的主动电话外展电话和简要 在一个CMHC(N=25名患者；N=33-50名提供者)中进行提供者干预，以获得有关可行性和 3个月实施期内的可接受性。在A3中，我们将进行第二类杂交的试点 在3家CMHC(N=50名患者；96-130名提供者)中进行的实施效果试验。我们将进行2个基线 评估(相隔3个月)和结果将在实施后3、6和12个月进行评估。 成果包括实施戒烟战略的可行性、可接受性和有效性 戒烟治疗利用(咨询和用药)与患者疗效 确认7天点流行戒酒)。意义：一项有效的 CMHC中的戒烟治疗是一种广泛的护理提供模式，将有大量的公众 对健康的影响。