Leveraging Community Pharmacists to Optimize Smoking Cessation Services for Rural Smokers in Appalachia

利用社区药剂师优化阿巴拉契亚农村吸烟者的戒烟服务

• 批准号: 10701777
• 负责人: Melissa Ashley Little
• 金额: $ 99.71万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-08 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10701777
• 关键词: Abstinence; Acceleration; Address; Adherence; Adoption; Affect; Appalachian Region; Area; Biochemical; Chronic Disease; Clinical; Code; Combined Modality Therapy; Communities; Community Pharmacy; Compensation; Counseling; Diabetes Mellitus; Documentation; Effectiveness; Face; Focus Groups; Future; Health; Health Promotion; Hypertension; Insurance Carriers; Intervention; Maintenance; Malignant Neoplasms; Medication Management; Methods; Modeling; National Cancer Institute; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Policies; Population; Prevalence; Primary Care; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Resources; Risk Factors; Rural; Rural Appalachia; Rural Population; Services; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Statutes and Laws; Surveys; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Tobacco-Related Carcinoma; Update; acceptability and feasibility; cigarette smoking; cost; effectiveness evaluation; evidence base; experimental study; follow-up; high risk; implementation evaluation; implementation fidelity; improved; incremental cost; medically underserved; medication compliance; nicotine gum; nicotine replacement; parity; post implementation; primary care setting; primary outcome; programs; quitline; recruit; relative cost; rural area; smoking cessation; smoking-related cancer; text messaging intervention; underserved area; underserved rural area; urban area

Rural Appalachian populations have the highest rates of cigarette smoking in the U.S. and are disproportionately affected by tobacco-related cancers. Publicly available smoking cessation resources (e.g., state quitlines, text-based interventions, nicotine replacement therapy [NRT]) are under-utilized by rural Appalachian smokers. Furthermore, rural Appalachia is medically underserved; thus, smoking cessation services within primary care settings face additional barriers. Community pharmacists, with their centralized placement in local communities and clinical expertise, are ideally situated to build capacity in underserved areas such as rural Appalachia to enhance existing smoking cessation resources for smokers. Research on pharmacist-delivered smoking cessation interventions is limited and does not provide for documentation and billing to compensate pharmacists for their time spent counseling patients. Medication Therapy Management (MTM), a pharmacist-delivered medication adherence approach that allows pharmacists to receive compensation for providing medication expertise, could be leveraged to promote smoking cessation. To address this gap, we developed an MTM intervention, QuitAid, to increase smoking cessation among rural smokers. QuitAid was based on a medication adherence intervention shown to be efficacious in a quitline setting. The purpose of the proposed study is to use a pragmatic approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to identify the essential components of an effective smoking cessation program that can easily integrate within community pharmacies in underserved rural areas. Smokers (n=768) recruited through 14 community pharmacies in rural Appalachia will be randomized in a 25 full factorial experiment to the following five treatments: (1) QuitAid (Yes vs. No), (2) tobacco quitline (Yes vs. No), (3) SmokefreeTXT (Yes vs. No), (4) Combination NRT Gum + NRT Patch (vs. NRT patch alone), and/or (5) 8 weeks of NRT (vs. standard 4 weeks). The primary outcome is biochemically- confirmed point prevalence abstinence at the 6-month follow-up. We will also assess implementation, including relative cost, as well as facilitators and barriers of reach, adoption, and maintenance of QuitAid and standard, evidence-based tobacco treatments through an ask-advise-connect method in community pharmacies. Our main hypothesis is that a smoking cessation MTM will increase smoking cessation and enhance reach and adherence to publicly available smoking cessation resources in medically underserved rural areas. The proposed study will: (1) provide foundational evidence for leveraging community pharmacists in underserved and rural areas to promote utilization of existing evidence-based tobacco cessation resources through enhanced MTM support, (2) inform updated national guidance on treating rural smokers, and (3) aid state legislation efforts related to pharmacy smoking cessation programs and policies. Ultimately, this research will inform strategies for smoking cessation in rural areas, such that cancer rates achieve parity with urban areas.

阿巴拉契亚农村人口的吸烟率是美国最高的， 不成比例地受到烟草相关癌症的影响。公开的戒烟资源（例如， 国家戒烟热线，基于文本的干预措施，尼古丁替代疗法[NRT]）在农村地区的使用不足 阿巴拉契亚的烟民此外，农村阿巴拉契亚是医疗服务不足，因此，戒烟， 初级保健机构内的服务面临更多的障碍。社区药剂师，他们 集中安置在当地社区和临床专业知识， 在服务不足的地区，如农村阿巴拉契亚，以加强现有的戒烟资源， 吸烟者。关于药剂师提供的戒烟干预措施的研究有限， 用于记录和计费，以补偿药剂师为患者提供咨询所花费的时间。药物 治疗管理（MTM），一种药剂师提供的药物依从性方法， 提供药物专业知识获得补偿，可以用来促进戒烟。 为了解决这一差距，我们开发了一种MTM干预措施，QuitAid，以增加农村居民的戒烟率。 吸烟者。QuitAid基于药物依从性干预，在戒烟线中显示有效 设置.本研究的目的是在Reach的指导下， 有效性、采用、实施和维护（RE-AIM）框架，以确定 一个有效的戒烟计划的组成部分，可以很容易地整合到社区药房 在服务不足的农村地区。通过阿巴拉契亚农村14家社区药房招募的吸烟者（n=768） 将在25全因子实验中随机分配至以下5种治疗：（1）QuitAid（是vs.否），（2） 戒烟灵（是vs.否），（3）无烟TXT（是vs.否），（4）复方NRT口香糖+ NRT贴片（vs. 单独NRT贴剂），和/或（5）8周NRT（与标准4周相比）。主要的结果是生物化学- 在6个月随访时证实了点患病率禁欲。我们还将评估执行情况，包括 相对成本，以及QuitAid和标准的推广、采用和维护的促进因素和障碍， 在社区药房通过“询问-建议-联系”方法提供循证烟草治疗。我们 主要假设是，戒烟MTM将增加戒烟和提高覆盖率， 在医疗服务不足的农村地区坚持公共戒烟资源。的 拟议的研究将：（1）提供利用社区药剂师在服务不足的基础证据 和农村地区，以促进现有循证戒烟资源的利用， 加强对MTM的支持，（2）告知有关治疗农村吸烟者的最新国家指南，以及（3）帮助国家 与药房戒烟计划和政策有关的立法工作。最终，这项研究将 为农村地区的戒烟战略提供信息，使癌症发病率与城市地区持平。