ORGANIZATIONAL CHANGE AND NICOTINE DEPENDENCE TREATMENT

酒精依赖者和艾滋病毒阳性者吸烟率高于一般人群，并导致与吸烟有关的发病率、死亡率和医疗保健费用增加。药物滥用治疗和艾滋病毒护理环境可能是提供尼古丁依赖治疗的最佳场所，但结构和态度障碍阻碍了实施。该中心部分将调查两个尼古丁依赖治疗TRC临床试验中每一个的诊所发生的组织变化，将观察到的变化与未参与临床试验的类似诊所的变化进行比较，并评估组织维持情况。 在临床试验完成后进行变更。 将对三家举办尼古丁依赖治疗TRC临床试验的诊所（干预组）与两家未举办TRC临床试验的诊所（对照组）进行尼古丁依赖治疗相关工作人员知识、态度和实践（KAP）的比较。将通过在4个时间点（基线、18个月、36个月和45个月）在每家诊所进行的劳动力调查收集数据。该研究将比较干预诊所（n=77）和对照诊所（n=43）的个体服务提供者的KAP，假设参与临床试验将增加对以下方面的了解： 尼古丁依赖及其治疗，对尼古丁依赖治疗的更有利的态度，以及改善的临床实践。 这一部分通过评估创新的客户层面干预措施的实施如何影响组织层面的态度和做法来扩展TRC临床试验，并将TRC的科学范围扩展到转化研究。长期目标是通过包括组织变革以推动采用创新干预措施来改善复杂环境中患者的治疗。

Alcohol dependent and HIV-positive individuals smoke at higher rates than the general population, and incur associated increases in smoking-related morbidity, mortality and healthcare costs. Substance abuse treatment and HIV care settings may be optimal venues for delivering nicotine dependence treatment, but structural and attitudinal barriers impede implementation. This Center component will investigate organizational changes that occur in clinics hosting each of the two TRC clinical trials of nicotine dependence treatment, compare observed changes with those in similar clinics not involved in the clinical trials, and assess maintenance of organizational change after the clinical trials are completed. Three clinics that host a TRC clinical trial of nicotine dependence treatment (intervention group) will be compared with two clinics that do not host a TRC clinical trial (control group) on staff knowledge, attitudes, and practices (KAP) related to nicotine dependence treatment. Data will be collected through a workforce survey conducted at each clinic at 4 time points: baseline, 18-months, 36-months and 45-months. The study will compare the KAP of individual service providers in the intervention clinics (n=77) with the KAP of those in the control clinics (n=43), with the hypotheses that clinical trial participation will produce increased knowledge of nicotine dependence and its treatment, more favorable attitudes towards nicotine dependence treatment, and improved clinical practices. This component extends the TRC clinical trials by assessing how the implementation of innovative client-level interventions may impact organizational-level attitudes and practices, and extends the scientific reach of the TRC into translational research. The long term goal is to improve the treatment of patients in complex settings by including organizational change to drive adoption of innovative interventions.