Examining the effect of a provider-delivered intervention among Medicaid smokers

描述(由申请者提供)：该项目的目标是测试由医生办公室提供的针对俄亥俄州阿巴拉契亚州医疗补助管理保健计划(MMCP)中登记的吸烟者的戒烟干预的可行性并获得初步疗效数据。在阿巴拉契亚地区参加医疗补助的人中，吸烟率为48%，是该州估计的两倍多(1)。两家服务于俄亥俄州阿巴拉契亚地区的MMCP已同意与我们合作，为该项目提供供应商和支持的名单。这项R21提案的具体目的是对医生、办公室工作人员和MMCP吸烟者进行定性研究，以更好地了解：1)医生和办公室工作人员的态度、规范和感知的行为控制；以及2)如何将科学有效的干预措施纳入MMCP办公室并交付给患者。2.测试医生办公室提供的干预措施的可行性，以促进：1)在阿巴拉契亚MMCP参与者中停止尝试和使用戒断药物治疗；2)由MMCP医生办公室提供5A；以及3)医生态度和感知的行为控制的改变。3.探索性：研究向MMCP参与者提供干预措施的成本-效果。这项研究将采用两阶段设计。在第一阶段，将使用定性研究来了解在MMCP医生办公室实施全面戒烟计划所涉及的问题。医生、他们的工作人员和MMCP吸烟者将被招募，并被要求进行定性访谈或焦点小组。第二阶段将包括针对医生办公室的干预的试点和可行性测试。干预的首要目标将是促进MMCP医生办公室的系统层面的变化，以促进医疗补助参与者的戒烟。干预措施将包括：1)实施烟草使用者识别系统；2)对医生进行教育和培训；3)定期向医生提供反馈；4)招聘和培训一名“办公室冠军”，以促进遵守干预措施。在第二阶段，将使用分组随机试验在俄亥俄州阿森斯县随机选择的8个医生办公室对干预进行试点测试(4个办公室将被随机分配到干预组，4个将被随机分配到对照组)。从每个医生办公室，总共将招募30名MMCP吸烟者，然后来进行医疗预约。结果，即24小时戒烟尝试和药物治疗的使用，将在登记后3个月在这些参与者中进行评估。 公共卫生相关性：公共卫生相关性在俄亥俄州阿巴拉契亚，16%的成年人参加了医疗补助计划，其中一半是目前的吸烟者。这项研究将提供重要的信息，以帮助减少俄亥俄州阿巴拉契亚州医疗补助参与者的吸烟。这些发现可能会推广到美国的其他农村和阿巴拉契亚社区。

DESCRIPTION (provided by applicant): The objectives of this project are to test the feasibility and obtain preliminary efficacy data for a physician office-delivered smoking cessation intervention targeting smokers enrolled in Medicaid Managed Care Programs (MMCPs) in Ohio Appalachia. The smoking prevalence is 48% among Medicaid enrollees in Appalachia, which is more than twice as high as the state estimate (1). Two MMCPs serving the Ohio Appalachian region have agreed to work with us by supplying a list of providers and support for the project. The specific aims of this R21 proposal are to perform a qualitative study with physicians, office staff, and MMCP smokers to better understand: 1) physician and office staff attitudes, norms, and perceived behavioral control; and 2) how a scientifically-valid intervention should be incorporated into an MMCP office and delivered to patients. 2. To test the feasibility of a physician office-delivered intervention in promoting: 1) quit attempts and use of cessation pharmacotherapy among Appalachian MMCP enrollees; 2) delivery of the 5A's by the MMCP physician offices; and 3) changes in physicians' attitudes and perceived behavioral control. 3. Exploratory: To examine the cost-effectiveness of delivering the intervention to MMCP enrollees. A two-phase design will be used for this study. In Phase I, qualitative research will be used to gain an understanding of the issues involved with implementing a comprehensive tobacco cessation program in MMCP physician offices. Physicians, their staff, and MMCP smokers will be recruited and asked to engage in qualitative interviews or focus groups. Phase II will consist of a pilot and feasibility test of the intervention targeting physician offices. The overarching goal of the intervention will be to promote systems-level changes in MMCP physician offices to promote smoking cessation among Medicaid enrollees. The intervention will include: 1) implementation of a tobacco-user identification system; 2) education and training of physicians; 3) periodic feedback to physicians; and 4) recruitment and training of an "office champion" to promote compliance with the intervention. For Phase II, a group-randomized trial will be used to pilot test the intervention in 8 randomly selected physician offices in Athens County, Ohio (4 offices will be randomized to the intervention and 4 to the control condition). From each physician office, a total of 30 MMCP smokers will be recruited as then come in for a medical appointment. Outcomes, which are quit attempts for 24 hours and use of pharmacotherapy, will be assessed among these participants at 3 months post-enrollment. PUBLIC HEALTH RELEVANCE: Public Health Relevance In Ohio Appalachia, 16% of adults are enrolled in the Medicaid program, and half of these individuals are current smokers. The research will provide important information to assist in reducing smoking among Medicaid enrollees in Ohio Appalachia. These findings may be generalizable to other rural and Appalachian communities in the United States.