Implementation of Cessation Treatment in Community Based Mental Health Centers

在社区精神卫生中心实施戒烟治疗

• 批准号: 10061586
• 负责人: Sandra Jane Japuntich
• 金额: $ 22.63万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10061586
• 关键词: Abstinence; Address; Adjuvant; Bupropion; Caring; Case Management; Chronic Care; Chronic Disease; Clinic; Communities; Contracts; Counseling; Disease Management; Effectiveness; Elements; Feasibility Studies; Feedback; Funding; General Population; Goals; Health Personnel; Health Services Accessibility; Hybrids; Individual; Information Dissemination; Infrastructure; Intervention; Interview; Laboratories; Leadership; Measures; Medication Management; Mental Health; Mental disorders; Modeling; Monitor; Outcome; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacotherapy; Pilot Projects; Practical, Robust Implementation and Sustainability Model; Prevalence; Provider; Psychiatric Diagnosis; Public Health; Relapse; Reporting; Research; Resources; Rhode Island; Risk; Safety; Science; Self Management; Service delivery model; Services; Site; Smoker; Smoking; Surveys; System; Technology Transfer; Telephone; Testing; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Training; United States Public Health Service; United States Substance Abuse and Mental Health Services Administration; acceptability and feasibility; addiction; base; chronic care model; cost effective; effectiveness implementation trial; efficacious treatment; evidence base; health disparity; implementation outcomes; implementation strategy; mental health center; mortality; multidisciplinary; nicotine replacement; outreach; patient subsets; pilot trial; primary outcome; provider intervention; psychiatric symptom; response; severe mental illness; smoking cessation; smoking prevalence; smoking-related disease; substance use prevention; telephone coaching; tobacco cessation intervention; tobacco user; treatment services; treatment strategy; trial design; varenicline

PROJECT SUMMAY / ABSTRACT BACKGROUND: The US Public Health Service (USPHS) designated tobacco dependence as a chronic disease. This is especially true for smokers with serious mental illness (SMI) who make more cessation attempts and are less successful sustaining long-term abstinence than the general population. There is a significant health disparity wherein individuals with SMI have a higher tobacco use prevalence and a greater risk for tobacco-related mortality than the general population. Chronic care models suggest chronic disease management requires a multidisciplinary care team to assess tobacco use, administer treatment, support patient self-management, and monitor progress. Proactive telephone outreach to smokers and brief provider interventions are two effective chronic disease management strategies. Community based mental health centers (CMHCs) are a primary treatment access point for many smokers with SMI. However, rates of intervention with smoking by CMHC providers are low. In order to implement the chronic care model for tobacco dependence for CMHCs, comprehensive implementation strategies are needed. OBJECTIVE: In response to PAR-18-223 we propose formative research and a feasibility pilot trial to adapt an implementation strategy developed by the SAMHSA-funded network of Addiction Technology Transfer Centers (ATTCs) to integrate a proactive, chronic care model of tobacco cessation treatment into CMHCs. AIMS: This study has 3 aims: (1) Adapt an evidence-based implementation strategy to CMHCs. (2) Pilot test the implementation strategy. (3) Conduct a pilot trial to assess the feasibility, acceptability and initial effectiveness of the implementation strategy. DESIGN: In A1, we will conduct stakeholder interviews of 22-29 patients, providers and site leaders in 4 CMHCs guided by the Practical, Robust Implementation and Sustainability Model to obtain information about adapting the ATTC science to service laboratory (SSL) implementation strategy. In A2 we will pilot the SSL strategy to implement proactive tobacco-related telephone outreach calls plus brief provider intervention in one CMHC (N=25 patients; N=33-50 providers) to obtain information on feasibility and acceptability over a 3-month implementation period. In A3 we will conduct a pilot hybrid type 2 implementation-effectiveness trial in 3 CMHCs (N=50 patients; 96-130 providers). We will conduct 2 baseline assessments (3 months apart) and outcomes will be assessed at 3, 6, and 12-months post implementation. Outcomes include feasibility, acceptability, effectiveness of the implementation strategy on tobacco cessation treatment utilization (counseling and medication) and patient effectiveness on tobacco cessation (CO confirmed 7-day point prevalence abstinence). SIGNIFICANCE: An effective implementation strategy for tobacco cessation treatment in CMHCs, a widespread model of care delivery, would have enormous public health impact.

项目总结/摘要 背景：美国公共卫生署（USPHS）将烟草依赖指定为慢性 疾病这对于患有严重精神疾病（SMI）的吸烟者来说尤其如此， 尝试和不太成功的维持长期禁欲比一般人群。有一个 显著的健康差异，其中患有SMI的个体具有更高的烟草使用流行率， 与烟草相关的死亡风险高于一般人群。慢性病护理模式表明慢性病 管理需要一个多学科的护理团队来评估烟草使用，实施治疗，支持 患者自我管理，并监测进展。主动电话联系吸烟者和简要提供者 干预措施是两种有效的慢性病管理策略。社区心理健康 CMHC是许多患有SMI的吸烟者的主要治疗接入点。然而， CMHC提供者对吸烟的干预很少。为了实施慢性病护理模式， 烟草依赖的CMHC，需要全面的实施战略。目的：通过 作为对PAR-18-223的回应，我们提出了形成性研究和可行性试点试验，以适应实施 由SAMHSA资助的成瘾技术转移中心（ATTC）网络制定的战略， 将戒烟治疗的主动、长期护理模式纳入CMHC。目的：本研究有3个 目标：（1）使基于证据的实施战略适用于CMHC。(2)试点测试实施 战略(3)进行先导试验，以评估 实施战略设计：在A1中，我们将对22-29名患者、提供者和患者的利益相关者进行访谈 在实用、稳健的实施和可持续发展模型的指导下， 获取有关适应ATTC科学服务实验室（SSL）实施战略的信息。在 答2：我们将试行SSL战略，以主动开展与烟草有关的电话外展活动， 提供者干预1例CMHC（N=25例患者; N=33-50名提供者），以获得可行性信息， 在3个月的实施期内可接受。在A3中，我们将进行混合动力2型试验 在3个CMHC（N=50名患者; 96-130名提供者）中进行的实施有效性试验。我们将进行2基线 评估（间隔3个月）和结果将在实施后3个月、6个月和12个月进行评估。 结果包括戒烟实施策略的可行性、可接受性和有效性 治疗利用率（咨询和药物治疗）和患者戒烟效果（CO 经证实的7天时点戒烟率）。重要性：有效的执行战略， CMHC中的戒烟治疗是一种广泛的护理模式， 健康影响。