Centralized Disease Management for Rural Hospitalized Smokers

描述（由申请人提供）：住院吸烟者与持续使用烟草有关的并发症风险很高。尽管全国都在关注住院患者的戒烟，但农村医院一直无法实施有效戒烟计划的完整组成部分。在“戒烟”的竞争更新中，我们经验丰富的多学科团队将建立在我们在农村社区戒烟研究的坚实基础上。针对处于戒烟准备阶段的吸烟者的“戒烟”项目表明，在疾病管理中，免费药物治疗与药物治疗管理相结合，可以使78%的吸烟者接受有效治疗。不幸的是，戒烟的免费药物治疗并不是普遍可用的。各州的戒烟项目供应有限，提供的选择也有限；虽然药物治疗的处方覆盖范围越来越广，但它没有得到充分利用，特别是在住院吸烟者的高危人群中。基于慢性护理模式，我们修订的疾病管理计划旨在提供咨询和疾病管理，同时提高药物治疗的利用率，并加强医疗保健提供者的支持。与Kan Quit相比，我们修订后的疾病管理方案将利用社区中已有的药物治疗资源。我们的具体目标是：1)评估集中疾病管理（CDM）对住院农村吸烟者戒烟的有效性；2)检验清洁发展机制对药物治疗利用的影响，并与卫生保健提供者进行讨论；3)阐明这些要素的利用如何介导CDM对戒烟的影响；4)检验清洁发展机制对戒烟的边际成本效益。这项研究将在堪萨斯州的30家农村危重医院进行。主要结局是通过唾液可替宁证实的7天点流行性戒断。住院的农村吸烟者将被随机分配到CDM组或单独咨询组（每组303人）。所有参与者将在第3、7、21和90天接受院内电话咨询和电话随访。第二次努力将在6个月后重新吸引持续或复发的吸烟者。对于清洁发展机制参与者，我们的烟草治疗专家还将在住院期间和出院后提供基于电话的疾病管理，包括与他们的保险计划相一致的药物治疗补充支持，并指导他们与卫生保健提供者建立有效的讨论。烟草治疗专家还将把治疗建议、处方请求和咨询建议传真给医疗保健提供者。拟议的研究将加强我们对戒烟疾病管理的理解，如果成功，有可能立即在农村关键医院实施。

DESCRIPTION (provided by applicant): Hospitalized smokers are at high risk for complications related to continued tobacco use. Although national attention has been directed at smoking cessation for hospitalized patients, rural hospitals have been unable to implement the complete components of effective smoking cessation programs. In this competitive renewal to Kan Quit, our experienced, multidisciplinary team will build upon our strong foundation of research on smoking cessation in rural communities. Kan Quit, directed at smokers in all stages of readiness to quit, demonstrated that disease management, in which free pharmacotherapy was combined with pharmacotherapy management, could engage 78% of smokers in effective treatment. Unfortunately, free pharmacotherapy for smoking cessation is not universally available. State smoking cessation programs have limited supplies and offer limited choices; although prescription coverage for pharmacotherapy is increasingly available, it is underutilized, particularly among the high-risk population of hospitalized smokers. Grounded in the Chronic Care Model, our revised disease management program is designed to provide counseling and disease management while increasing utilization of pharmacotherapy and enhancing support from healthcare providers. In contrast to Kan Quit, our revised disease management program will take advantage of resources for pharmacotherapy already available in the community. Our specific objectives are to 1) evaluate the effectiveness of Centralized Disease Management (CDM) for smoking cessation among hospitalized rural smokers; 2) test the impact of CDM on utilization of pharmacotherapy and discussions with health care providers; 3) clarify how utilization of these elements may mediate the effect of CDM on smoking cessation; and 4) examine the marginal cost effectiveness of CDM for smoking cessation. This study will be conducted in 30 rural critical access hospitals in Kansas. The primary outcome is 7-day point prevalence abstinence confirmed by salivary cotinine. Hospitalized rural smokers will be randomized to either CDM or counseling (C) alone (303 in each arm). All participants will receive in-hospital telephone counseling with telephone follow-up at days 3, 7, 21, and 90. A second effort will be made to re-engage persistent or relapsed smokers 6 months later. For CDM participants, our Tobacco Treatment Specialist will also provide telephone-based disease management during the hospitalization and after discharge, including supplemental support for pharmacotherapy that is consistent with their insurance plan and guidance on establishing effective discussions with their health care provider. The Tobacco Treatment Specialist will also fax treatment recommendations, prescription requests, and counseling suggestions to the healthcare provider. The proposed research will enhance our understanding of disease management for smoking cessation and, if successful, has the potential for immediate implementation in rural critical access hospitals.