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

描述（由申请人提供）：本项目的目的是测试可行性，并获得医生办公室提供的戒烟干预措施的初步疗效数据，目标是在俄亥俄州阿巴拉契亚州参加医疗补助管理医疗计划（MMCPs）的吸烟者。阿巴拉契亚地区医疗补助计划参保者的吸烟率为48%，是州政府估计的两倍多(1)。为俄亥俄州阿巴拉契亚地区提供服务的两家mmcp已同意与我们合作，为该项目提供供应商名单和支持。本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、规范和感知行为控制；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. 检验医师办公室干预在促进：1)阿巴拉契亚MMCP入选者戒烟尝试和使用戒烟药物治疗的可行性；2)由MMCP医师办公室提供5A；3)医生态度和行为控制感知的变化。3. 探索性：考察向MMCP参保者提供干预措施的成本效益。本研究将采用两阶段设计。在第一阶段，定性研究将用于了解在MMCP医生办公室实施全面戒烟计划所涉及的问题。将招募医生、他们的工作人员和MMCP吸烟者，并要求他们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。干预的总体目标将是促进MMCP医生办公室的系统级变化，以促进医疗补助计划参保者戒烟。干预措施将包括：1)实施烟草使用者识别系统；2)医师的教育和培训；3)定期向医生反馈；4)招聘和培训“办公室冠军”，促进合规干预。在第二阶段，将采用一组随机试验，在俄亥俄州阿森斯县随机选择8个医生办公室进行干预试验（4个办公室将随机分配到干预组，4个办公室将随机分配到对照组）。从每个医生办公室，总共将招募30名MMCP吸烟者来进行医疗预约。结果，即24小时的戒烟尝试和药物治疗的使用，将在这些参与者入组后3个月进行评估。

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.