Disease Management for Smokers in Rural Primary Care

吸烟和吸烟引起的并发症不成比例地影响生活在农村的人们。 社区.以前促进戒烟的策略主要是以城市为基础的，涉及短时间， 长期干预，登记的吸烟者已经有戒烟的动机，并且没有很好地融入初级保健 实践尼古丁成瘾可能更好地被概念化为一种慢性疾病， 使用较新的慢性病管理模式解决。吸烟的疾病管理方法 戒烟将为多次戒烟尝试提供支持，治疗准备戒烟的所有阶段的吸烟者， 与初级卫生保健提供者协调戒烟工作。 本研究的主要目的是评估高强度和低强度疾病管理的有效性 尼古丁依赖的治疗方案在这项研究中，我们将从20个农村，初级保健诊所招募750名吸烟者， 堪萨斯。受试者将被随机分配至三个研究组之一，每组提供20个月的治疗： C（对照组）、LDM（低强度疾病管理）或HDM（高强度疾病管理）。 C组的参与者将收到健康教育邮件和免费尼古丁替代疗法的提议 (six周）或安非他酮（七周）每6个月（第0、6、12和18个月）。LDM的参与者将 接受与C相同的干预措施，加上一个低强度的疾病管理计划，包括一个单一的 在0、6、12和18个月时使用动机访谈（MI）进行电话咨询，以鼓励 戒烟尝试，还包括协调吸烟评估和药物治疗， 病人的医生。HDM参与者将接受C+高强度疾病管理计划， 包括在0、6、12和18个月时进行多达6次基于电话的MI咨询会议，以鼓励吸烟。 戒烟尝试和预防戒烟尝试后复吸，以及协调吸烟评估， 戒烟尝试和患者医生的药物治疗。 该研究的主要结果是在吸烟后2年的7天点戒烟率。 招生次要结局包括：1）戒烟尝试次数和2）改变阶段的进展。如果 如果成功，这种干预将为解决尼古丁依赖提供一个可推广的模型， 改善初级保健中吸烟的长期管理。

Cigarette smoking and complications from cigarette smoking disproportionately affect people living in rural communities. Previous strategies to promote smoking cessation have largely been urban-based, involved short- term interventions, enrolled smokers already motivated to quit, and been poorly integrated into primary care practice. Nicotine addiction may be better conceptualized as a chronic illness that might be most effectively addressed using newer models of chronic disease management. A disease management approach to smoking cessation would provide support for multiple quit attempts, treat smokers of all stages of readiness to quit, and coordinate cessation efforts with primary health care providers. The primary aim of this study is to assess the effectiveness of both high and low intensity, disease management programs for nicotine dependence. In this study, we will recruit 750 smokers from 20 rural, primary care clinics in Kansas. Subjects will be randomly assigned to one of three study arms, each providing 20 months of treatment: C (comparison group), LDM (low-intensity disease management) or HDM (high-intensity disease management). Participants in group C will receive health educational mailings and an offer for free nicotine replacement therapy (six weeks) or bupropion (seven weeks) every 6 months (months 0, 6, 12, and 18). Participants in LDM will receive the same interventions as C plus a low-intensity disease management program that includes a single telephone counseling session using motivational interviewing (MI)at months 0, 6, 12, and 18 to encourage a cessation attempt and also includes coordination of smoking assessments and pharmacotherapy with the patient's physician. HDM participants will receive C plus a high intensity disease management program that includes up to six telephone-based MI counseling sessions at months 0, 6, 12, and 18 to encourage a smoking cessation attempt and to prevent relapse after a quit attempt, as well as coordination of smoking assessments, quit attempts, and pharmacotherapy with the patient's physician. The primary outcome of the study is 7-day point prevalence abstinence from cigarettes at 2 years after enrollment. Secondary outcomes include: 1) number of quit attempts and 2) progress in stage of change. If successful, this intervention will provide a generalizable model for addressing nicotine dependence that could improve long-term management of smoking in primary care.