Connect to Quit: Coordinated Care for Smoking Cessation among Low Income Veterans

连接戒烟：低收入退伍军人戒烟的协调护理

• 批准号: 7741901
• 负责人: Hilary A. Tindle
• 金额: $ 64.41万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7741901
• 关键词: Abstinence; Address; Adult; Alcohol abuse; Alcohol or Other Drugs use; Annual Reports; Area; Attention; Behavior Therapy; Behavioral; Caring; Cessation of life; Chronic; Chronic Disease; Clinical Practice Guideline; Clinical Trials; Clinical Trials Design; Computerized Medical Record; Cost Measures; Data; Diabetes Mellitus; Disease; Effectiveness; Effectiveness of Interventions; Enrollment; Evidence based intervention; Evidence based treatment; FDA approved; Face; Facilities and Administrative Costs; Feedback; Goals; Guidelines; Health; Healthcare; Healthcare Systems; Homelessness; Household; Hypertension; Income; Individual; Intention; Intervention; Justice; Knowledge; Low Income Population; Low income; Measures; Mediating; Medical; Military Personnel; National Formulary; Nicotine; Outpatients; Patients; Performance; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Plant Roots; Population; Positioning Attribute; Prevalence; Primary Health Care; Process; Process Measure; Provider; Questionnaires; Randomized; Readiness; Recycling; Relapse; Reporting; Research; Research Personnel; Resources; Risk; Services; Smoke; Smoker; Smoking; Stable Populations; Staging; Substance abuse problem; Surveys; System; Techniques; Testing; Time; Tobacco; Tobacco Use Cessation; Tobacco use; United States; United States Department of Veterans Affairs; Veterans; Visit; base; brief intervention; care systems; chronic care model; cost; cost effectiveness; design; disorder later incidence prevention; evidence base; experience; improved; motivational enhancement therapy; novel; population based; programs; public health relevance; smoking cessation; smoking intervention; smoking prevalence; social; standard of care; therapy design; tobacco control; treatment as usual; treatment planning

DESCRIPTION (provided by applicant): Despite a reduction in smoking prevalence in the general United States adult population over the past 4 decades, the prevalence of smoking remains high among low income adults and low income veterans of the United States military. Despite the highly-advanced, population-based approach to tobacco control in the Veterans Administration (VHA) health care system, low income smokers remain difficult to treat. A pervasive, nationwide lack of approach to smoking as a chronic disease, with high relapse rates and multiple quit attempts per smoker even in the best of circumstances, is a critical deficit in the current standard of care for low income smokers, who are even less likely than wealthier individuals to quit smoking, and more likely to relapse when they do quit. The goal of this application is to examine the effectiveness of an intervention designed to reduce smoking in low income adults within a regional United States Veterans Administration (VHA) health care system. We propose a pro-active, personalized, coordinated system of care (Connect to Quit (CTQ)) which is rooted in the Chronic Care Model. CTQ treats smoking as a chronic condition that, like hypertension or diabetes, requires long term treatment with appropriate combinations of behavioral therapy and pharmacotherapy. CTQ will be evaluated in the context of 3 VA Pittsburgh Healthcare System (VAPHS) medical practices which care for ~2,400 low-income smokers, 93% of whom report an annual household income below $36,000 (27% make < $10K; 37% make from $10-$19,999K; 23% make from $20-$29,999K; and only 13% make > $30,000). Approximately 40 Primary Care Providers (PCPs, including non-physicians) in VAPHS (and their low income patients making < $36,000/year) will be invited to be randomized to either CTQ or Usual Care (UC, existing VHA services, without additional CTQ services). Desire to quit smoking is not required for participation in the study, as the point of CTQ is to engage smokers at every level of readiness to quit. Approximately 480 low income smokers in each group are expected to enroll and be followed for a minimum of 2 years. Investigators will measure abstinence (biochemically-validated 30 day point-prevalence) at the end of 2 years and over a 2-year period (measured every 6 months). Direct and indirect costs of care will be assessed to calculate the incremental cost per successful quit of CTQ vs. UC. Investigators will explore mediating effects of process measures related to treatment utilization and behavioral processes (of enrolled patients and providers) on the impact of CTQ. This proposal is led by Dr. Tindle, a new investigator, and represents a collaborative effort by investigators with complementary expertise, experience, and positioning to execute the study. The conservatively-estimated impact of CTQ to increase abstinence by ~5% above and beyond UC (representing a 50-100% increase in cessation) at two years would result in ~50,000 fewer low income smokers in the national VA population of low income veterans, and ~300,000 fewer if projected nationally to all low-income smokers. PUBLIC HEALTH RELEVANCE: Smoking is the leading preventable cause of disease and death in the United States and in the world, yet smoking remains common among people with low income, such as low income veterans of the United States military. This project will test how well a program called "Connect to Quit" helps low income veterans quit smoking. The program treats smoking as an ongoing health condition that, like high blood pressure or diabetes, needs a combination of ongoing support, classes, and medication. The results of this project will improve our understanding of how to help low income veterans successfully quit smoking.

描述（由申请人提供）：尽管在过去40年中，美国一般成年人群的吸烟率有所下降，但美国军队中低收入成年人和低收入退伍军人的吸烟率仍然很高。尽管在退伍军人管理局（VHA）的医疗保健系统中采用了高度先进的、基于人群的烟草控制方法，但低收入吸烟者仍然难以治疗。全国范围内普遍缺乏将吸烟作为一种慢性疾病的方法，即使在最好的情况下，每个吸烟者也有高复发率和多次戒烟尝试，这是目前低收入吸烟者护理标准的一个关键缺陷，他们甚至比富裕的人更不可能戒烟，而且更有可能在戒烟后复吸。本申请的目的是检查旨在减少美国退伍军人管理局（VHA）医疗保健系统内低收入成年人吸烟的干预措施的有效性。 我们提出了一个积极的，个性化的，协调的护理系统（连接到退出（CTQ）），这是植根于慢性护理模式。CTQ将吸烟视为一种慢性疾病，如高血压或糖尿病，需要长期治疗，适当结合行为疗法和药物疗法。CTQ将在3个VA匹兹堡医疗保健系统（VAPHS）医疗实践的背景下进行评估，该系统为约2，400名低收入吸烟者提供护理，其中93%的人报告家庭年收入低于36，000美元（27%的人赚不到1万美元; 37%的人赚10 - 19, 999 K美元; 23%的人赚20 - 29, 999 K美元;只有13%的人赚30,000美元）。将邀请VAPHS中约40名初级保健提供者（PCP，包括非医生）（及其年收入<36，000美元的低收入患者）随机分配至CTQ或家庭护理（UC，现有VHA服务，无额外CTQ服务）。参与本研究不需要戒烟意愿，因为CTQ的目的是让吸烟者参与戒烟的各个准备阶段。预计每组约有480名低收入吸烟者入组并接受至少2年的随访。研究者将在2年结束时和2年期间（每6个月测量一次）测量禁欲（生物化学验证的30天点患病率）。将评估直接和间接护理成本，以计算每次成功退出CTQ与UC的增量成本。研究者将探索与治疗利用和行为过程（入组患者和提供者）相关的过程测量对CTQ影响的中介作用。 该提案由新研究者Tindle博士领导，代表了研究者的合作努力，他们具有互补的专业知识，经验和定位来执行研究。保守估计，CTQ在两年时将戒烟率提高约5%，超过UC（代表戒烟率增加50-100%），这将导致全国退伍军人管理局低收入退伍军人人群中的低收入吸烟者减少约50，000人，如果在全国范围内预测所有低收入吸烟者减少约300，000人。 公共卫生相关性：吸烟是美国和世界上主要的可预防的疾病和死亡原因，但吸烟在低收入人群中仍然很常见，例如美国军队的低收入退伍军人。这个项目将测试一个名为“连接戒烟”的项目如何帮助低收入退伍军人戒烟。该计划将吸烟视为一种持续的健康状况，就像高血压或糖尿病一样，需要持续的支持，课程和药物治疗。该项目的结果将提高我们对如何帮助低收入退伍军人成功戒烟的理解。