Do Practice Guidelines Reduce Smoking in Schizophrenia

描述：(申请人提供) 吸烟和尼古丁成瘾是严重的健康问题 精神分裂症患者，他们的吸烟率是一般人的两倍 人口。卫生保健研究和质量机构(AHRQ)最近 推广循证戒烟实践指南。AHRQ 报告总结了强有力的证据表明，这些做法的实施 对多个人群的临床影响。然而，它们还没有经过测试 在精神分裂症患者中。这项研究测试了实施 AHRQ关于医生提供的简短戒烟指南 对确诊为精神分裂症的人进行干预。我们假设 与在提供标准服务的机构接受治疗的患者相比 护理，参与者在实施这些AHRQ的机构接受治疗 指导方针将增加戒烟尝试；增加戒烟准备 戒烟；增加戒烟/戒烟；以及减少 每天吸烟。我们还假设，延长干预持续时间 而忠于指导方针将产生更好的结果。一种准实验 这项研究将比较接受与AHRQ实践一致的护理的患者 对接受不符合惯例的护理的患者的指导方针 指导方针。马里兰州随机选择的六家门诊精神卫生诊所 将被录取；将随机分配3人来实施指导方针 立即(实验条件)，并将实施12年的指导方针 3个月，将把准则的实施推迟6个月 (控制条件)，然后实施指南6个月。评估 患者结局，随机选择63名精神分裂症患者在 每个诊所(初始注册总人数为378人)将进行三次评估 积分。考虑到自然减员，我们估计最终样本至少有50个 在我们的第一个假设中，每个诊所的参与者(150人，总共300人)。 实践准则的实施将通过强化培训来实现 研究现场的工作人员，持续监测和协助，并提供诊所 激励措施。富达将通过图表审查和 参与者面谈。该设计建议分层数据结构，即， 个别患者嵌套在医生内部，医生嵌套在一起 在诊所内。因此，将利用多层次分析来解决 研究假设。与传统技术相比，这种技术有许多优点 多元回归(或ANCOVA)分析，包括检验假设的能力 关于跨级影响(例如，AHRQ如何实施(医生级 预测者)影响患者水平的结果。它还为受试者提供 缺少数据，以及类内测量不独立(医生或 临床)或类内相关性可以被估计和控制。

DESCRIPTION: (provided by applicant) Cigarette smoking and nicotine addiction are significant health problems among people with schizophrenia, who smoke at double the rate of the general population. The Agency for Health Care Research and Quality (AHRQ) has recently promoted of evidenced-based practice guidelines for smoking cessation. The AHRQ report summarizes strong evidence that implementation of these practices has clinical impact across multiple populations. However, they have not been tested among persons with schizophrenia. This study tests the impact of implementing the AHRQ guidelines for brief, physician-delivered smoking cessation interventions among people with schizophrenia diagnoses. We hypothesize that when compared to patients receiving treatment at agencies providing standard care, participants receiving treatment at agencies implementing these AHRQ guidelines will have increased attempts to quit smoking; increased readiness to quit smoking; increased smoking cessation/abstinence; and, decreased amount of smoking per day. We also hypothesize that increased duration of intervention and fidelity to guidelines will produce better outcomes. A quasi-experimental study will compare patients receiving care consistent with the AHRQ practice guidelines to patients receiving care that is not consistent with the practice guidelines. Six randomly selected outpatient mental health clinics in Maryland will be enrolled; 3 will be randomly assigned to implement the guidelines immediately (experimental condition) and will implement the guidelines for 12 months, and 3 will delay implementation of the guidelines for six months (control condition) and then implement the guidelines for 6 months. To assess patient outcomes, a randomly selected sample of 63 schizophrenia patients at each clinic (total initial enrollment 378) will be assessed at three time points. Accounting for attrition, we estimate a final sample of at least 50 participants per clinic (150per condition, 300 total) for our first hypothesis. Implementation of practice guidelines will be achieved by intensive training of staff at study sites, ongoing monitoring and assistance, and providing clinic incentives. Fidelity will be closely monitored by a chart review and participant interview. The design suggests a hierarchical data structure, i.e., individual patients are nested within physicians and physicians are nested within clinics. Thus, a multilevel analysis will be utilized to address the research hypotheses. This technique has numerous advantages over traditional multiple regression (or ANCOVA) analysis, including capacity to test hypotheses about cross-level effects (e.g., how AHRQ implementation (a physician-level predictor) affects patient-level outcomes. It also accommodates subjects with missing data, and non-independence of measures within-class (physician or clinic) or intra-class correlation can be estimated and controlled.