TOBACCO TREATMENT OUTREACH TO REDUCE DISPARITIES FOR PRIMARY CARE POPULATIONS

项目摘要： 在美国，吸烟仍然是可预防的主要死因， 肺癌的病因虽然吸烟率在过去几十年里有所下降，但仍有 吸烟的巨大差异。重要的是，低社会经济地位（SES）和少数吸烟者有 由于各种原因，包括更有限的治疗机会，错误的信息， 关于治疗方案的风险和益处，更多的环境暴露，缺乏社会支持，以及 其他生活压力。虽然大多数吸烟者每年都去看初级保健医生，但忙碌的临床医生 在访问期间经常不讨论烟草使用问题。少数族裔和低社会经济地位吸烟者比白人更有可能 报告他们在访问期间没有得到咨询或治疗。由于这些原因， 提供系统的机会，在提供者的办公室之外进行烟草治疗。 交互式语音应答（IVR）是一种电话技术，允许计算机检测语音响应 在一个普通的电话。这项技术提供了一种低成本、高效率的方式， 人口，独立的访问。该项目的目标是开发和评估一个多层次的 低SES和少数民族患者的烟草治疗方法。这些组成部分包括：（1）IVR便利 有系统的外展，与烟草治疗专家联系，并指导免费尼古丁替代疗法 该计划与以下两个方面相结合：（2）通过电子健康记录（EHR）与个人的初级保健医生进行整合，并提供与烟草相关的综合决策支持，以及（3）转介到定制的社区资源，以解决戒烟的社会背景障碍。 因此，我们提出以下具体目标：具体目标1：为低SES和少数吸烟者制定一个EHR相关的、IVR介导的定制烟草治疗计划。具体目标二：通过在Partners Primary Care Practice Based Research Network中对低SES和少数吸烟者进行随机对照试验来衡量这种定制治疗方案的有效性。本试验的主要结局是6个月时的7天戒烟率。具体目标3：评估这一量身定制的烟草治疗计划的推广、采用和实施的促进因素和障碍。

Project Summary: Smoking remains the leading preventable cause of death in the United States (US), and is a well established cause of lung cancer. Although smoking rates have declined over the past several decades, there remain substantial disparities in smoking . Importantly, low socioeconomic status (SES) and minority smokers have a more difficult time quitting for a variety of reasons including more limited access to treatment, misinformation about the risks and benefits of treatment options, more environmental exposure, lack of social support, and other life stressors. While the majority of smokers visit a primary care physicain each year, busy clinicians frequently do not address tobacco use during a visit. Minority and low SES smokers are more likely than whites to report that they did not receive counseling or treatment during a visit. For these reasons it is important to offer systematic opportunities for tobacco treatment beyond the provider's office. Interactive Voice Response (IVR) is a phone technology that allows a computer to detect voice responses during a normal phone call. This technology offers a low-cost, efficient way to proactively reach out to large populations, independent of a visit. The objectives of this project are to develop and evaluate a multi-level approach to tobacco treatment for low-SES and minority patients. The components include: (1) IVR-facilitated systematic outreach, linkage to a tobacco treatment specialist, and free nicotine replacement therapy directed at the patient, and integration of this program with both (2) an individual's primary care physician through an electronic health record (EHR) with integrated tobacco-related decision support, and (3) referral to tailored community resources to address the socio-contextual barriers to tobacco cessation. We therefore propose the following Specific Aims: Specific Aim 1: To develop an EHR-linked, IVR-mediated tailored tobacco treatment program for low-SES and minority smokers. Specific Aim 2: To measure the effectiveness of this tailored treatment program by conducting a randomized controlled trial of low SES and minority smokers in the Partners Primary Care Practice Based Research Network. The primary outcome of this trial will be the 7-day abstinence rate at 6 months. Specific Aim 3: To evaluate facilitators and barriers to the reach, adoption, and implementation of this tailored tobacco treatment program.