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针对俄亥俄州阿巴拉契亚参加医疗补助管理护理计划（MMCP）的吸烟者的医生办公室提供的戒烟干预的可行性并获得初步疗效数据。在阿巴拉契亚的医疗补助登记者中，吸烟率为48%，是州估计值的两倍多（1）。服务于俄亥俄州阿巴拉契亚地区的两个MMCP已经同意与我们合作，为该项目提供供应商和支持。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、规范和感知的行为控制; 2）如何将科学有效的干预纳入MMCP办公室并提供给患者。2.测试医生办公室提供的干预措施在促进以下方面的可行性：1）在阿巴拉契亚MMCP登记者中戒烟尝试和使用戒烟药物治疗; 2）MMCP医生办公室提供5A; 3）医生态度和感知行为控制的变化。3.探索性：检查向MMCP登记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，并要求从事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措施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，以促进医疗补助注册者戒烟。干预措施将包括：（1）实施烟草使用者身份识别系统;（2）教育和培训医生;（3）定期向医生提供反馈;（4）招聘和培训“办公室卫士”，以促进对干预措施的遵守。对于II期，将在俄亥俄州雅典县的8个随机选择的医生办公室中进行一项分组随机试验，对干预进行初步测试（4个办公室将随机分配至干预组，4个办公室分配至对照组）。从每个医生办公室，总共将招募30名MMCP吸烟者，然后进行医疗预约。将在入组后3个月评估这些受试者的结局，即24小时内尝试戒烟和使用药物治疗。 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，以协助减少俄亥俄州阿巴拉契亚医疗补助计划注册者的吸烟。这些发现可能是推广到其他农村和阿巴拉契亚社区在美国。

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.