Fax to Quit: Linking Smokers Visiting Clinics to State Quitlines

描述(由申请人提供)：在今天的美国，烟草使用是一种独特的致命性、普遍性和疏忽的状况，尽管有有效的干预措施可用。这种令人不安的情况突出表明，需要传播有效的干预措施，以便有意义地减少烟草使用的流行率。在现有的循证治疗方案中，电话戒烟可能提供了最大的未实现的承诺，帮助很大一部分美国吸烟者成功戒烟。戒烟电话是治疗烟草依赖的有效方法。由于强有力的经验支持，所有50个州现在都提供全州范围的停电服务。然而，戒烟线的覆盖率或人口渗透率一直很低(每年吸烟者的比例为1%-3%)，而促进戒烟线使用的传统手段-付费媒体宣传活动和与戒烟线使用有关的药物赠送-对于正在努力应对烟草控制资金下降的州来说，往往昂贵得令人望而却步。传真到戒烟-一种将州戒烟热线与每年去看初级保健医生的70%的吸烟者联系起来的策略-已被确定为一种以潜在较低的成本增加戒烟热线覆盖范围的方法。操作上，每一位进行初级保健访问的烟草使用者都会被问及S是否有兴趣戒烟并接受戒烟咨询。如果S同意，转介将被传真(或电子传输)到州戒烟热线，然后州热线主动联系烟草使用者。这一战略的潜力已导致40多个州实施了某种形式的传真退出。然而，这一有希望的方法还没有得到充分的评估，一些证据表明，传真退出转诊和连接率往往很低。这项提案旨在系统地评估两种形式的传真戒烟：单独传真戒烟(FQ)和传真戒烟加增强的学术细节(FQ+EAD)，EAD包括持续的培训/技术援助和绩效反馈。在收集了戒烟转介的基线比率后，40家诊所将被随机接受FQ或FQ+EAD。将测量诊所转介率、退出热线患者接触者和“优质接触者”(当推荐导致个人加入退出热线咨询服务时)。此外，一个定性研究部分将评估这两种干预措施的关键方面，一项经济分析将比较两种传真退出干预措施的成本与媒体和其他现有不在线宣传战略的成本。该提案旨在满足本RFA的研究目标；利用循证干预进行转化性研究，有可能促进2010年健康人加强健康促进和疾病预防的目标。

DESCRIPTION (provided by applicant): In America today, tobacco use stands out as a condition of unique lethality, prevalence, and neglect, despite the availability of effective interventions. This troubling set of circumstances highlights the need to disseminate effective interventions so as to meaningfully reduce tobacco use prevalence. Among available evidence-based treatment options, telephone quitlines may offer the greatest unrealized promise to help a large proportion of U.S. smokers to successfully quit. Telephone quitlines are effective treatments for tobacco dependence. As a result of strong empirical support, all 50 states now provide statewide quitline services. Yet the reach, or population penetrance, of quitlines has been low (1-3% of smokers annually) and traditional means of boosting quitline use - paid media campaigns and medication give-aways linked to quitline use - are often prohibitively expensive for states struggling with declining tobacco control funding. Fax to Quit - a strategy to link state quitlines to the 70% of smokers who visit a primary care physician each year - has been identified as a means of increasing quitline reach at potentially lower cost. Operationally, every tobacco user making a primary care visit is asked if s/he is interested in quitting and receiving quitline counseling. If s/he agrees, a referral is faxed (or transmitted electronically) to the state quitline, which then proactively contacts the tobacco user. The potential of this strategy has led more than 40 states to implement some form of Fax to Quit. Yet, this promising approach has not been adequately evaluated and some evidence indicates that Fax to Quit referral and connection rates are often low. This proposal is designed to systematically evaluate two forms of Fax to Quit: Fax to Quit alone (FQ) and Fax to Quit plus Enhanced Academic Detailing (FQ + EAD) with EAD comprising ongoing training/technical assistance and performance feedback. After collecting baseline rates of quitline referrals, 40 clinics will be randomized to receive either FQ or FQ + EAD. Clinic referral rates, quitline-patient contacts, and "quality contacts" (when referrals result in the individual enrolling in quitline counseling services) will be measured. In addition, a qualitative research component will evaluate key aspects of the two interventions and an economic analysis will compare the cost of the two Fax to Quit interventions to the costs of media and other current quitline promotional strategies. The proposal is designed to meet the research objectives of this RFA; to conduct translational research using an evidence-based intervention that has the potential to foster the Healthy People 2010 goals of enhanced health promotion and disease prevention.