Implementing Tobacco Control in Dental Practice

描述(由申请人提供)：在这项HMO系统水平的随机对照有效性试验中，我们将评估一种创新和实用的团队方法在大型牙科HMO中为感兴趣的吸烟者提供戒烟帮助的可行性、有效性、成本效益和可持续性。我们和其他人已经证明了5A模式在医疗和牙科环境中的有效性。在全国范围内，在常规实践中实施和维护5A模式的询问和建议部分取得了进展，但在协助和安排部分方面取得的进展较少，特别是在牙科实践中。实施的障碍是巨大的。需要更多实用和创新的方法，将对工作人员的要求降至最低，同时利用临床接触创造的“可教时刻”，鼓励更多患者获得和使用便捷的戒烟支持服务。图表审查显示，KP牙医和卫生员目前为几乎所有吸烟者提供简单的建议，但不提供戒烟帮助。在这项研究中，14家大型机构中的一半的牙医和卫生员将接受培训，将吸烟者的电话连接到专业人员的烟草戒烟热线，作为牙科就诊的一部分。如果患者愿意，退出热线的工作人员会在更方便的时间打电话给他们。Quitline的工作人员将提供简短的咨询和评估以及完整的戒烟服务菜单，包括多时段电话和面对面的计划和药物。这种积极的转诊策略既实用又创新，因为它利用了可用的资源；有效地在牙医、卫生员和咨询专家之间分配干预活动；并可以在个人、小型或大型牙科诊所提供。将对随机选择的2800名接受牙科检查的患者(n-2800)在实施期间的早期或后期进行服务提供和一年的戒烟结果进行评估。KP牙科计划的规模很大(160,000名成员)，因此对拟议的方法进行评估是可行的。这些发现将是可推广的，因为工作人员的练习方式和访问流程与其他练习环境相似，基于电话的免费电话服务通过国家运营的免费电话广泛提供。

DESCRIPTION (provided by applicant): In this HMO system-level randomized controlled effectiveness trial, we will evaluate the feasibility, effectiveness, cost-effectiveness, and sustainability of an innovative and practical team approach for delivering smoking cessation assistance to interested smokers in a large dental HMO. We, and others, have demonstrated the efficacy of the 5A model in medical and dental settings. Progress has been made nationally in implementing and maintaining the Ask and Advise components of the 5A model in routine practice, but less progress has been made with the Assist and Arrange components, particularly in dental practice. Barriers to implementation are significant. More practical and innovative approaches are needed that minimize demands on staff, yet take advantage of the "teachable moment" created by the clinical encounter to encourage more patients to access and use convenient cessation support services. Chart reviews show that KP dentists and hygienists currently provide simple advice to almost all smokers, but do not provide cessation assistance. In this study, dentists and hygienists in half of 14 large facilities will be trained to connect tobacco users by phone to a professionally staffed tobacco quitline as a part of the dental visit. If patients prefer, quitline staff will call them at a more convenient time. Quitline staff will provide brief counseling and assessment and a full menu of cessation services, including multi-session telephone and face-to-face programs and medications. This Active Referral strategy is both practical and innovative, as it takes advantage of available resources; efficiently distributes intervention activities between dentists, hygienists, and counseling specialists; and could be delivered in individual, small, or large dental practices. Service delivery and one-year cessation outcomes will be assessed for randomly selected treatment and control patients (n--2,800) with dental exam visits either early or later in the implementation period. The large size of the KP dental plan (160,000 members) makes it feasible to evaluate the proposed approach. The findings will be generalizable because the practice style and visit flow for staff is similar to other practice settings, and telephone-based quitline services are widely available through state-run quitlines.