ORGANIZATIONAL CHANGE AND NICOTINE DEPENDENCE TREATMENT

酒精依赖者和艾滋病毒阳性个体的吸烟率高于一般人群，并导致与吸烟有关的发病率、死亡率和保健费用相应增加。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。本中心的组成部分将调查在两个TRC尼古丁依赖治疗临床试验中发生的组织变化，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，并评估组织的维持

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.