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）：尽管在过去的40年里，美国普通成年人的吸烟率有所下降，但在美国低收入成年人和低收入退伍军人中，吸烟率仍然很高。尽管退伍军人管理局（VHA）卫生保健系统采用了高度先进的、以人群为基础的烟草控制方法，但低收入吸烟者仍然难以治疗。在全国范围内普遍缺乏将吸烟视为一种慢性疾病的方法，即使在最好的情况下，每个吸烟者的复发率也很高，并且多次尝试戒烟，这是目前低收入吸烟者护理标准中的一个严重缺陷，低收入吸烟者戒烟的可能性甚至比富裕的人更小，而且在戒烟后更有可能复发。本应用程序的目的是检查旨在减少美国退伍军人管理局（VHA）地区卫生保健系统中低收入成年人吸烟的干预措施的有效性。