Implementing Tobacco Control in Dental Practice

描述（由申请人提供）：在这项HMO系统级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的可行性、有效性、成本效益和可持续性，该方法用于为大型牙科HMO中感兴趣的吸烟者提供戒烟帮助。我们和其他人已经证明了5A模型在医疗和牙科环境中的有效性。在全国范围内，在日常实践中实施和维护5A模式的询问和建议部分方面取得了进展，但在协助和安排部分方面取得的进展较小，特别是在牙科实践中。执行方面的障碍很大。需要更实用和创新的方法，最大限度地减少对工作人员的要求，同时利用临床接触创造的“可教时刻”，鼓励更多的患者获得和使用方便的戒烟支持服务。图表审查显示，金伯利进程牙医和戒烟者目前提供简单的建议，几乎所有的吸烟者，但不提供戒烟援助。在这项研究中，14个大型机构中有一半的牙医和牙医将接受培训，通过电话将烟草使用者与专业人员戒烟热线联系起来，作为牙科就诊的一部分。如果病人愿意，戒烟热线的工作人员会在更方便的时候打电话给他们。戒烟热线的工作人员将提供简短的咨询和评估，以及一个完整的戒烟服务菜单，包括多个会议的电话和面对面的程序和药物。这种主动转诊策略既实用又创新，因为它利用了现有资源;有效地在牙医，牙医和咨询专家之间分配干预活动;并且可以在个人，小型或大型牙科诊所中提供。将对随机选择的治疗和对照患者（n-2，800）的服务提供和一年的戒烟结果进行评估，这些患者在实施期间的早期或后期进行牙科检查。金伯利进程牙科计划的规模很大（160 000名成员），因此可以对拟议的办法进行评估。调查结果将是可推广的，因为工作人员的实践风格和访问流程与其他实践环境相似，并且通过国营戒烟热线广泛提供基于电话的戒烟服务。

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.